Foerster, Beat, Abufaraj, Mohammad, Matin, Surena F., Azizi, Mounsif, Gupta, Mohit, Li, Wei-Ming, Seisen, Thomas, Clinton, Timothy, Xylinas, Evanguelos, Mir, M. Carmen, Schweitzer, Donald, Mari, Andrea, Kimura, Shoji, Bandini, Marco, Mathieu, Romain, Ku, Ja H., Marcq, Gautier, Guruli, Georgi, Grabbert, Markus, Czech, Anna K., Muilwijk, Tim, Pycha, Armin, D'Andrea, David ORCID: 0000-0003-1625-1077, Petros, Firas G., Spiess, Philippe E., Bivalacqua, Trinity, Wu, Wen-Jeng, Roupret, Morgan, Krabbe, Laura-Maria, Hendricksen, Kees, Egawa, Shin, Briganti, Alberto, Moschini, Marco, Graffeille, Vivien, Kassouf, Wassim, Autorino, Riccardo, Heidenreich, Axel, Chlosta, Piotr, Joniau, Steven, Soria, Francesco, Pierorazio, Phillip M. and Shariat, Shahrokh F. (2021). Pretreatment Risk Stratification for Endoscopic Kidney-sparing Surgery in Upper Tract Urothelial Carcinoma: An International Collaborative Study. Eur. Urol., 80 (4). S. 507 - 516. AMSTERDAM: ELSEVIER. ISSN 1873-7560

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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 < 0.001), biopsy cT1+ staging (OR 3.23, 95% CI 1.93-5.41, p < 0.001), preoperative hydronephrosis (OR 1.37 95% CI 1.04-1.80, p = 0.024), tumor size (OR 1.09, 95% CI 1.01-1.17, p = 0.029), invasion on imaging (OR 5.10, 95% CI 3.32-7.81, p < 0.001), and sessile architecture (OR 2.31, 95% CI 1.58-3.36, p < 0.001) were significantly associated with >= pT2/pN+ disease. Compared with the existing models, our model had the highest performance accuracy (75% vs 66-71%) and an additional clinical net reduction (four per 100 patients). Conclusions: Our proposed risk-stratification model predicts the risk of harboring >= pT2/N+ UTUC with reliable accuracy and a clinical net benefit outperforming the current risk-stratification models. Patient summary: We developed a risk stratification model to better identify patients for endoscopic kidney-sparing surgery in upper tract urothelial carcinoma. (C) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Foerster, BeatUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abufaraj, MohammadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matin, Surena F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Azizi, MounsifUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gupta, MohitUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Li, Wei-MingUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seisen, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clinton, TimothyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Xylinas, EvanguelosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mir, M. CarmenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schweitzer, DonaldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mari, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kimura, ShojiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bandini, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mathieu, RomainUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ku, Ja H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marcq, GautierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guruli, GeorgiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grabbert, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Czech, Anna K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muilwijk, TimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pycha, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
D'Andrea, DavidUNSPECIFIEDorcid.org/0000-0003-1625-1077UNSPECIFIED
Petros, Firas G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Spiess, Philippe E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bivalacqua, TrinityUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wu, Wen-JengUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roupret, MorganUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krabbe, Laura-MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hendricksen, KeesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Egawa, ShinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Briganti, AlbertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moschini, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Graffeille, VivienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kassouf, WassimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Autorino, RiccardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heidenreich, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chlosta, PiotrUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Joniau, StevenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Soria, FrancescoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pierorazio, Phillip M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shariat, Shahrokh F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-607663
DOI: 10.1016/j.eururo.2021.05.004
Journal or Publication Title: Eur. Urol.
Volume: 80
Number: 4
Page Range: S. 507 - 516
Date: 2021
Publisher: ELSEVIER
Place of Publication: AMSTERDAM
ISSN: 1873-7560
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PREOPERATIVE PLASMA-LEVELS; RADICAL NEPHROURETERECTOMY; HISTOLOGICAL VARIANTS; PROGNOSTIC-FACTORS; OUTCOMES; GRADE; HYDRONEPHROSIS; PREDICTION; DIAGNOSIS; DISEASEMultiple languages
Urology & NephrologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60766

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