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Pretreatment Risk Stratification for Endoscopic Kidney-sparing Surgery in Upper Tract Urothelial Carcinoma: An International Collaborative Study
- Source :
- European Urology. 80:507-515
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- BACKGROUND: Several groups have proposed features to identify low-risk patients who may benefit from endoscopic kidney-sparing surgery in upper tract urothelial carcinoma (UTUC). OBJECTIVE: To evaluate standard risk stratification features, develop an optimal model to identify ≥pT2/N+ stage at radical nephroureterectomy (RNU), and compare it with the existing unvalidated models. DESIGN, SETTING, AND PARTICIPANTS: This was a collaborative retrospective study that included 1214 patients who underwent ureterorenoscopy with biopsy followed by RNU for nonmetastatic UTUC between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We performed multiple imputation of chained equations for missing data and multivariable logistic regression analysis with a stepwise selection algorithm to create the optimal predictive model. The area under the curve and a decision curve analysis were used to compare the models. RESULTS AND LIMITATIONS: Overall, 659 (54.3%) and 555 (45.7%) patients had ≤pT1N0/Nx and ≥pT2/N+ disease, respectively. In the multivariable logistic regression analysis of our model, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.0-1.03, p = 0.013), high-grade biopsy (OR 1.81, 95% CI 1.37-2.40, p
- Subjects :
- Urologic Neoplasms
medicine.medical_specialty
PREDICTION
Urology
030232 urology & nephrology
DIAGNOSIS
Kidney
Logistic regression
Risk Assessment
DISEASE
03 medical and health sciences
PROGNOSTIC-FACTORS
0302 clinical medicine
HYDRONEPHROSIS
Biopsy
medicine
Humans
Stage (cooking)
Risk stratification
Retrospective Studies
OUTCOMES
Carcinoma, Transitional Cell
Science & Technology
medicine.diagnostic_test
Ureteral Neoplasms
business.industry
Radical nephroureterectomy
Area under the curve
Retrospective cohort study
Odds ratio
Urology & Nephrology
Stepwise regression
Confidence interval
PREOPERATIVE PLASMA-LEVELS
Surgery
GRADE
Urinary Bladder Neoplasms
Upper tract urothelial carcinoma
030220 oncology & carcinogenesis
HISTOLOGICAL VARIANTS
Kidney-sparing surgery
business
Life Sciences & Biomedicine
Subjects
Details
- ISSN :
- 03022838
- Volume :
- 80
- Database :
- OpenAIRE
- Journal :
- European Urology
- Accession number :
- edsair.doi.dedup.....0154d17b2689b20497c9dcb27690a993