A Preoperative Nomogram to Predict Renal Function Insufficiency for Cisplatin-based Adjuvant Chemotherapy Following Minimally Invasive Radical Nephroureterectomy (ROBUUST Collaborative Group)

Zhenjie Wu, Qi Chen, Hooman Djaladat, Andrea Minervini, Robert G. Uzzo, Chandru P. Sundaram, Koon H. Rha, Mark L. Gonzalgo, Reza Mehrazin, Elio Mazzone, Jamil Marcus, Alyssa Danno, James Porter, Aeen Asghar, Fady Ghali, Georgi Guruli, Antoin Douglawi, Giovanni Cacciamani, Alireza Ghoreifi, Giuseppe SimoneVitaly Margulis, Matteo Ferro, Riccardo Tellini, Andrea Mari, Abhishek Srivastava, James Steward, Ali Al-Qathani, Ahmad Al-Mujalhem, Amit Satish Bhattu, Alexander Mottrie, Firas Abdollah, Daniel D. Eun, Ithaar Derweesh, Alessandro Veccia, Riccardo Autorino, Linhui Wang

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)173-181
Number of pages9
JournalEuropean Urology Focus
Issue number1
Publication statusPublished - 2022 Jan

Bibliographical note

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

All Science Journal Classification (ASJC) codes

  • Urology


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