Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma

Laura Maria Krabbe, Okyaz Eminaga, Shahrokh F. Shariat, Ryan C. Hutchinson, Yair Lotan, Arthur I. Sagalowsky, Jay D. Raman, Christopher G. Wood, Alon Z. Weizer, Marco Roscigno, Francesco Montorsi, Christian Bolenz, Giacomo Novara, Eiji Kikuchi, Harun Fajkovic, Leonid M. Rapoport, Peter V. Glybochko, Richard Zigeuner, Mesut Remzi, Karim BensalahWassim Kassouf, Vitaly Margulis

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose We developed a prognostic nomogram for patients with high grade urothelial carcinoma of the upper urinary tract after extirpative surgery. Materials and Methods Clinical data were available for 2,926 patients diagnosed with high grade urothelial carcinoma of the upper urinary tract who underwent extirpative surgery. Cox proportional hazard regression models identified independent prognosticators of relapse in the development cohort (838). A backward step-down selection process was applied to achieve the most informative nomogram with the least number of variables. The L2-regularized logistic regression was applied to generate the novel nomogram. Harrell's concordance indices were calculated to estimate the discriminative accuracy of the model. Internal validation processes were performed using bootstrapping, random sampling, tenfold cross-validation, LOOCV, Brier score, information score and F1 score. External validation was performed on an external cohort (2,088). Decision tree analysis was used to develop a risk classification model. Kaplan-Meier curves were applied to estimate the relapse rate for each category. Results Overall 35.3% and 30.7% of patients experienced relapse in the development and external validation cohort. The final nomogram included age, pT stage, pN stage and architecture. It achieved a discriminative accuracy of 0.71 and 0.76, and the AUC was 0.78 and 0.77 in the development and external validation cohort, respectively. Rigorous testing showed constant results. The 5-year relapse-free survival rates were 88.6%, 68.1%, 40.2% and 12.5% for the patients with low risk, intermediate risk, high risk and very high risk disease, respectively. Conclusions The current nomogram, consisting of only 4 variables, shows high prognostic accuracy and risk stratification for patients with high grade urothelial carcinoma of the upper urinary tract following extirpative surgery, thereby adding meaningful information for clinical decision making.

Original languageEnglish
Pages (from-to)580-589
Number of pages10
JournalJournal of Urology
Volume197
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

Fingerprint

Nomograms
Carcinoma
Recurrence
Survival
Urinary Tract
Decision Trees
Decision Support Techniques
Proportional Hazards Models
Area Under Curve
Survival Rate
Logistic Models

Keywords

  • carcinoma
  • nomograms
  • prognosis
  • recurrence
  • transitional cell

ASJC Scopus subject areas

  • Urology

Cite this

Krabbe, L. M., Eminaga, O., Shariat, S. F., Hutchinson, R. C., Lotan, Y., Sagalowsky, A. I., ... Margulis, V. (2017). Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma. Journal of Urology, 197(3), 580-589. https://doi.org/10.1016/j.juro.2016.09.078

Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma. / Krabbe, Laura Maria; Eminaga, Okyaz; Shariat, Shahrokh F.; Hutchinson, Ryan C.; Lotan, Yair; Sagalowsky, Arthur I.; Raman, Jay D.; Wood, Christopher G.; Weizer, Alon Z.; Roscigno, Marco; Montorsi, Francesco; Bolenz, Christian; Novara, Giacomo; Kikuchi, Eiji; Fajkovic, Harun; Rapoport, Leonid M.; Glybochko, Peter V.; Zigeuner, Richard; Remzi, Mesut; Bensalah, Karim; Kassouf, Wassim; Margulis, Vitaly.

In: Journal of Urology, Vol. 197, No. 3, 01.03.2017, p. 580-589.

Research output: Contribution to journalArticle

Krabbe, LM, Eminaga, O, Shariat, SF, Hutchinson, RC, Lotan, Y, Sagalowsky, AI, Raman, JD, Wood, CG, Weizer, AZ, Roscigno, M, Montorsi, F, Bolenz, C, Novara, G, Kikuchi, E, Fajkovic, H, Rapoport, LM, Glybochko, PV, Zigeuner, R, Remzi, M, Bensalah, K, Kassouf, W & Margulis, V 2017, 'Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma', Journal of Urology, vol. 197, no. 3, pp. 580-589. https://doi.org/10.1016/j.juro.2016.09.078
Krabbe, Laura Maria ; Eminaga, Okyaz ; Shariat, Shahrokh F. ; Hutchinson, Ryan C. ; Lotan, Yair ; Sagalowsky, Arthur I. ; Raman, Jay D. ; Wood, Christopher G. ; Weizer, Alon Z. ; Roscigno, Marco ; Montorsi, Francesco ; Bolenz, Christian ; Novara, Giacomo ; Kikuchi, Eiji ; Fajkovic, Harun ; Rapoport, Leonid M. ; Glybochko, Peter V. ; Zigeuner, Richard ; Remzi, Mesut ; Bensalah, Karim ; Kassouf, Wassim ; Margulis, Vitaly. / Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma. In: Journal of Urology. 2017 ; Vol. 197, No. 3. pp. 580-589.
@article{0ec69a5532f7409489a4bedc8133fe24,
title = "Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma",
abstract = "Purpose We developed a prognostic nomogram for patients with high grade urothelial carcinoma of the upper urinary tract after extirpative surgery. Materials and Methods Clinical data were available for 2,926 patients diagnosed with high grade urothelial carcinoma of the upper urinary tract who underwent extirpative surgery. Cox proportional hazard regression models identified independent prognosticators of relapse in the development cohort (838). A backward step-down selection process was applied to achieve the most informative nomogram with the least number of variables. The L2-regularized logistic regression was applied to generate the novel nomogram. Harrell's concordance indices were calculated to estimate the discriminative accuracy of the model. Internal validation processes were performed using bootstrapping, random sampling, tenfold cross-validation, LOOCV, Brier score, information score and F1 score. External validation was performed on an external cohort (2,088). Decision tree analysis was used to develop a risk classification model. Kaplan-Meier curves were applied to estimate the relapse rate for each category. Results Overall 35.3{\%} and 30.7{\%} of patients experienced relapse in the development and external validation cohort. The final nomogram included age, pT stage, pN stage and architecture. It achieved a discriminative accuracy of 0.71 and 0.76, and the AUC was 0.78 and 0.77 in the development and external validation cohort, respectively. Rigorous testing showed constant results. The 5-year relapse-free survival rates were 88.6{\%}, 68.1{\%}, 40.2{\%} and 12.5{\%} for the patients with low risk, intermediate risk, high risk and very high risk disease, respectively. Conclusions The current nomogram, consisting of only 4 variables, shows high prognostic accuracy and risk stratification for patients with high grade urothelial carcinoma of the upper urinary tract following extirpative surgery, thereby adding meaningful information for clinical decision making.",
keywords = "carcinoma, nomograms, prognosis, recurrence, transitional cell",
author = "Krabbe, {Laura Maria} and Okyaz Eminaga and Shariat, {Shahrokh F.} and Hutchinson, {Ryan C.} and Yair Lotan and Sagalowsky, {Arthur I.} and Raman, {Jay D.} and Wood, {Christopher G.} and Weizer, {Alon Z.} and Marco Roscigno and Francesco Montorsi and Christian Bolenz and Giacomo Novara and Eiji Kikuchi and Harun Fajkovic and Rapoport, {Leonid M.} and Glybochko, {Peter V.} and Richard Zigeuner and Mesut Remzi and Karim Bensalah and Wassim Kassouf and Vitaly Margulis",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.juro.2016.09.078",
language = "English",
volume = "197",
pages = "580--589",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma

AU - Krabbe, Laura Maria

AU - Eminaga, Okyaz

AU - Shariat, Shahrokh F.

AU - Hutchinson, Ryan C.

AU - Lotan, Yair

AU - Sagalowsky, Arthur I.

AU - Raman, Jay D.

AU - Wood, Christopher G.

AU - Weizer, Alon Z.

AU - Roscigno, Marco

AU - Montorsi, Francesco

AU - Bolenz, Christian

AU - Novara, Giacomo

AU - Kikuchi, Eiji

AU - Fajkovic, Harun

AU - Rapoport, Leonid M.

AU - Glybochko, Peter V.

AU - Zigeuner, Richard

AU - Remzi, Mesut

AU - Bensalah, Karim

AU - Kassouf, Wassim

AU - Margulis, Vitaly

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Purpose We developed a prognostic nomogram for patients with high grade urothelial carcinoma of the upper urinary tract after extirpative surgery. Materials and Methods Clinical data were available for 2,926 patients diagnosed with high grade urothelial carcinoma of the upper urinary tract who underwent extirpative surgery. Cox proportional hazard regression models identified independent prognosticators of relapse in the development cohort (838). A backward step-down selection process was applied to achieve the most informative nomogram with the least number of variables. The L2-regularized logistic regression was applied to generate the novel nomogram. Harrell's concordance indices were calculated to estimate the discriminative accuracy of the model. Internal validation processes were performed using bootstrapping, random sampling, tenfold cross-validation, LOOCV, Brier score, information score and F1 score. External validation was performed on an external cohort (2,088). Decision tree analysis was used to develop a risk classification model. Kaplan-Meier curves were applied to estimate the relapse rate for each category. Results Overall 35.3% and 30.7% of patients experienced relapse in the development and external validation cohort. The final nomogram included age, pT stage, pN stage and architecture. It achieved a discriminative accuracy of 0.71 and 0.76, and the AUC was 0.78 and 0.77 in the development and external validation cohort, respectively. Rigorous testing showed constant results. The 5-year relapse-free survival rates were 88.6%, 68.1%, 40.2% and 12.5% for the patients with low risk, intermediate risk, high risk and very high risk disease, respectively. Conclusions The current nomogram, consisting of only 4 variables, shows high prognostic accuracy and risk stratification for patients with high grade urothelial carcinoma of the upper urinary tract following extirpative surgery, thereby adding meaningful information for clinical decision making.

AB - Purpose We developed a prognostic nomogram for patients with high grade urothelial carcinoma of the upper urinary tract after extirpative surgery. Materials and Methods Clinical data were available for 2,926 patients diagnosed with high grade urothelial carcinoma of the upper urinary tract who underwent extirpative surgery. Cox proportional hazard regression models identified independent prognosticators of relapse in the development cohort (838). A backward step-down selection process was applied to achieve the most informative nomogram with the least number of variables. The L2-regularized logistic regression was applied to generate the novel nomogram. Harrell's concordance indices were calculated to estimate the discriminative accuracy of the model. Internal validation processes were performed using bootstrapping, random sampling, tenfold cross-validation, LOOCV, Brier score, information score and F1 score. External validation was performed on an external cohort (2,088). Decision tree analysis was used to develop a risk classification model. Kaplan-Meier curves were applied to estimate the relapse rate for each category. Results Overall 35.3% and 30.7% of patients experienced relapse in the development and external validation cohort. The final nomogram included age, pT stage, pN stage and architecture. It achieved a discriminative accuracy of 0.71 and 0.76, and the AUC was 0.78 and 0.77 in the development and external validation cohort, respectively. Rigorous testing showed constant results. The 5-year relapse-free survival rates were 88.6%, 68.1%, 40.2% and 12.5% for the patients with low risk, intermediate risk, high risk and very high risk disease, respectively. Conclusions The current nomogram, consisting of only 4 variables, shows high prognostic accuracy and risk stratification for patients with high grade urothelial carcinoma of the upper urinary tract following extirpative surgery, thereby adding meaningful information for clinical decision making.

KW - carcinoma

KW - nomograms

KW - prognosis

KW - recurrence

KW - transitional cell

UR - http://www.scopus.com/inward/record.url?scp=85010447506&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010447506&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2016.09.078

DO - 10.1016/j.juro.2016.09.078

M3 - Article

C2 - 27670916

AN - SCOPUS:85010447506

VL - 197

SP - 580

EP - 589

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 3

ER -