TY - JOUR
T1 - A Preoperative Nomogram to Predict Renal Function Insufficiency for Cisplatin-based Adjuvant Chemotherapy Following Minimally Invasive Radical Nephroureterectomy (ROBUUST Collaborative Group)
AU - Wu, Zhenjie
AU - Chen, Qi
AU - Djaladat, Hooman
AU - Minervini, Andrea
AU - Uzzo, Robert G.
AU - Sundaram, Chandru P.
AU - Rha, Koon H.
AU - Gonzalgo, Mark L.
AU - Mehrazin, Reza
AU - Mazzone, Elio
AU - Marcus, Jamil
AU - Danno, Alyssa
AU - Porter, James
AU - Asghar, Aeen
AU - Ghali, Fady
AU - Guruli, Georgi
AU - Douglawi, Antoin
AU - Cacciamani, Giovanni
AU - Ghoreifi, Alireza
AU - Simone, Giuseppe
AU - Margulis, Vitaly
AU - Ferro, Matteo
AU - Tellini, Riccardo
AU - Mari, Andrea
AU - Srivastava, Abhishek
AU - Steward, James
AU - Al-Qathani, Ali
AU - Al-Mujalhem, Ahmad
AU - Bhattu, Amit Satish
AU - Mottrie, Alexander
AU - Abdollah, Firas
AU - Eun, Daniel D.
AU - Derweesh, Ithaar
AU - Veccia, Alessandro
AU - Autorino, Riccardo
AU - Wang, Linhui
N1 - Funding Information:
Funding/Support and role of the sponsor: This work was supported by National Natural Science Foundation of China ( 82072825 and 81874093 to Zhenjie Wu, 81730073 and 81872074 to Linhui Wang); Program of Shanghai Hospital New Star ( YYXX-WZJ to Zhenjie Wu); Program of Shanghai Hospital Development Center ( SHDC12018108 to Linhui Wang); Special Clinical Research in Health Industry in Shanghai ( 20184Y0054 to Qi Chen); and Shanghai Sail Program ( 19YF1459200 to Qi Chen).
Publisher Copyright:
© 2021 European Association of Urology
PY - 2022/1
Y1 - 2022/1
N2 - Background: Postoperative renal function impairment represents a main limitation for delivering adjuvant chemotherapy after radical nephroureterectomy (RNU). Objective: To create a model predicting renal function decline after minimally invasive RNU. Design, setting, and participants: A total of 490 patients with nonmetastatic UTUC who underwent minimally invasive RNU were identified from a collaborative database including 17 institutions worldwide (February 2006 to March 2020). Renal function insufficiency for cisplatin-based regimen was defined as estimated glomerular filtration rate (eGFR) <50 ml/min/1.73 m2 at 3 mo after RNU. Patients with baseline eGFR >50 ml/min/1.73 m2 (n = 361) were geographically divided into a training set (n = 226) and an independent external validation set (n = 135) for further analysis. Outcome measurements and statistical analysis: Using transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines, a nomogram to predict postoperative eGFR <50 ml/min/1.73 m2 was built based on the coefficients of the least absolute shrinkage and selection operation (LASSO) logistic regression. The discrimination, calibration, and clinical use of the nomogram were investigated. Results and limitations: The model that incorporated age, body mass index, preoperative eGFR, and hydroureteronephrosis was developed with an area under the curve of 0.771, which was confirmed to be 0.773 in the external validation set. The calibration curve demonstrated good agreement. Besides, the model was converted into a risk score with a cutoff value of 0.583, and the difference between the low- and high-risk groups both in overall death risk (hazard ratio [HR]: 4.59, p < 0.001) and cancer-specific death risk (HR: 5.19, p < 0.001) was statistically significant. The limitation mainly lies in its retrospective design. Conclusions: A nomogram incorporating immediately available clinical variables can accurately predict renal insufficiency for cisplatin-based adjuvant chemotherapy after minimally invasive RNU and may serve as a tool facilitating patient selection. Patient summary: We have developed a model for the prediction of renal function loss after radical nephroureterectomy to facilitate patient selection for perioperative chemotherapy.
AB - Background: Postoperative renal function impairment represents a main limitation for delivering adjuvant chemotherapy after radical nephroureterectomy (RNU). Objective: To create a model predicting renal function decline after minimally invasive RNU. Design, setting, and participants: A total of 490 patients with nonmetastatic UTUC who underwent minimally invasive RNU were identified from a collaborative database including 17 institutions worldwide (February 2006 to March 2020). Renal function insufficiency for cisplatin-based regimen was defined as estimated glomerular filtration rate (eGFR) <50 ml/min/1.73 m2 at 3 mo after RNU. Patients with baseline eGFR >50 ml/min/1.73 m2 (n = 361) were geographically divided into a training set (n = 226) and an independent external validation set (n = 135) for further analysis. Outcome measurements and statistical analysis: Using transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines, a nomogram to predict postoperative eGFR <50 ml/min/1.73 m2 was built based on the coefficients of the least absolute shrinkage and selection operation (LASSO) logistic regression. The discrimination, calibration, and clinical use of the nomogram were investigated. Results and limitations: The model that incorporated age, body mass index, preoperative eGFR, and hydroureteronephrosis was developed with an area under the curve of 0.771, which was confirmed to be 0.773 in the external validation set. The calibration curve demonstrated good agreement. Besides, the model was converted into a risk score with a cutoff value of 0.583, and the difference between the low- and high-risk groups both in overall death risk (hazard ratio [HR]: 4.59, p < 0.001) and cancer-specific death risk (HR: 5.19, p < 0.001) was statistically significant. The limitation mainly lies in its retrospective design. Conclusions: A nomogram incorporating immediately available clinical variables can accurately predict renal insufficiency for cisplatin-based adjuvant chemotherapy after minimally invasive RNU and may serve as a tool facilitating patient selection. Patient summary: We have developed a model for the prediction of renal function loss after radical nephroureterectomy to facilitate patient selection for perioperative chemotherapy.
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U2 - 10.1016/j.euf.2021.01.014
DO - 10.1016/j.euf.2021.01.014
M3 - Article
C2 - 33549537
AN - SCOPUS:85100380666
SN - 2405-4569
VL - 8
SP - 173
EP - 181
JO - European Urology Focus
JF - European Urology Focus
IS - 1
ER -
