Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function

Patrick J Hensley; Craig Labbate; Andrew Zganjar; Jeffrey Howard; Heather Huelster; Trey Durdin; Jonathan Pham; Lianchun Xiao; Maximilian Pallauf; Kara Lombardo; Ilya Glezerman; Nirmish Singla; Jay D Raman; Jonathan Coleman; Philippe E Spiess; Vitaly Margulis; Aaron M Potretzke; Surena F Matin

doi:10.1016/j.euo.2024.01.005

Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function

Patrick J Hensley, Craig Labbate, Andrew Zganjar, Jeffrey Howard, Heather Huelster, Trey Durdin, Jonathan Pham, Lianchun Xiao, Maximilian Pallauf (Co-author), Kara Lombardo, Ilya Glezerman, Nirmish Singla, Jay D Raman, Jonathan Coleman, Philippe E Spiess, Vitaly Margulis, Aaron M Potretzke, Surena F Matin

Department of Urology and Andrology

Research output: Contribution to journal › Original Article › peer-review

Abstract

BACKGROUND AND OBJECTIVE: The timing of perioperative nephrotoxic chemotherapy for upper tract urothelial carcinoma (UTUC) remains controversial and strongly depends on predicted platinum eligibility after radical nephroureterectomy (RNU). The study objective was to develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) following RNU.

METHODS: This was a multi-institutional retrospective study of patients with UTUC treated with RNU from 2000 to 2020 at seven high-volume referral centers. Use of adjuvant chemotherapy was risk-stratified. Patients were retrospectively randomly allocated 2:1 to discovery and validation cohorts. Discovery data were used to identify independent factors associated with GFR at 1-3 mo after RNU on linear regression, and backward selection was applied for model construction. Accuracy was defined as the percentage of predicted eGFR results within 30% of the corresponding observed eGFR.

KEY FINDINGS AND LIMITATIONS: We included 1100 patients, of whom 733 were in the discovery and 367 were in the validation cohort. Multivariable predictors of postoperative eGFR decline included advanced age (odds ratio [OR] -0.18, 95% confidence interval [CI] -0.28 to -0.08), diabetes (OR -2.38, 95% CI -4.64 to -0.11), and hypertension (OR -2.24, 95% CI -4.16 to -0.32). Factors associated with favorable postoperative eGFR included larger tumor size (OR 10.57, 95% CI 7.4-13.74 for tumors >5 cm vs ≤2 cm) and preoperative eGFR (OR 0.44, 95% CI 0.39-0.49). A composite nomogram predicted postoperative eGFR with good accuracy in both the discovery (80.5%) and validation (78.6%) cohorts. Limitations include exclusion of patients who received neoadjuvant chemotherapy.

CONCLUSIONS: A nomogram that incorporates ubiquitous preoperative clinical variables can predict post-RNU eGFR and was validated with an independent cohort.

PATIENT SUMMARY: We developed a tool that uses patient data to predict eligibility for chemotherapy after surgery to remove the kidney and ureter in patients with cancer in the upper urinary tract.

Original language	English
Journal	EUROPEAN UROLOGY ONCOLOGY
DOIs	https://doi.org/10.1016/j.euo.2024.01.005
Publication status	E-pub ahead of print - 1 Feb 2024

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Hensley, P. J., Labbate, C., Zganjar, A., Howard, J., Huelster, H., Durdin, T., Pham, J., Xiao, L., Pallauf, M., Lombardo, K., Glezerman, I., Singla, N., Raman, J. D., Coleman, J., Spiess, P. E., Margulis, V., Potretzke, A. M., & Matin, S. F. (2024). Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function. EUROPEAN UROLOGY ONCOLOGY. Advance online publication. https://doi.org/10.1016/j.euo.2024.01.005

@article{396e97de7adb421097b10147059df525,

title = "Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function",

abstract = "BACKGROUND AND OBJECTIVE: The timing of perioperative nephrotoxic chemotherapy for upper tract urothelial carcinoma (UTUC) remains controversial and strongly depends on predicted platinum eligibility after radical nephroureterectomy (RNU). The study objective was to develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) following RNU.METHODS: This was a multi-institutional retrospective study of patients with UTUC treated with RNU from 2000 to 2020 at seven high-volume referral centers. Use of adjuvant chemotherapy was risk-stratified. Patients were retrospectively randomly allocated 2:1 to discovery and validation cohorts. Discovery data were used to identify independent factors associated with GFR at 1-3 mo after RNU on linear regression, and backward selection was applied for model construction. Accuracy was defined as the percentage of predicted eGFR results within 30% of the corresponding observed eGFR.KEY FINDINGS AND LIMITATIONS: We included 1100 patients, of whom 733 were in the discovery and 367 were in the validation cohort. Multivariable predictors of postoperative eGFR decline included advanced age (odds ratio [OR] -0.18, 95% confidence interval [CI] -0.28 to -0.08), diabetes (OR -2.38, 95% CI -4.64 to -0.11), and hypertension (OR -2.24, 95% CI -4.16 to -0.32). Factors associated with favorable postoperative eGFR included larger tumor size (OR 10.57, 95% CI 7.4-13.74 for tumors >5 cm vs ≤2 cm) and preoperative eGFR (OR 0.44, 95% CI 0.39-0.49). A composite nomogram predicted postoperative eGFR with good accuracy in both the discovery (80.5%) and validation (78.6%) cohorts. Limitations include exclusion of patients who received neoadjuvant chemotherapy.CONCLUSIONS: A nomogram that incorporates ubiquitous preoperative clinical variables can predict post-RNU eGFR and was validated with an independent cohort.PATIENT SUMMARY: We developed a tool that uses patient data to predict eligibility for chemotherapy after surgery to remove the kidney and ureter in patients with cancer in the upper urinary tract.",

author = "Hensley, {Patrick J} and Craig Labbate and Andrew Zganjar and Jeffrey Howard and Heather Huelster and Trey Durdin and Jonathan Pham and Lianchun Xiao and Maximilian Pallauf and Kara Lombardo and Ilya Glezerman and Nirmish Singla and Raman, {Jay D} and Jonathan Coleman and Spiess, {Philippe E} and Vitaly Margulis and Potretzke, {Aaron M} and Matin, {Surena F}",

note = "Pallauf: Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria",

year = "2024",

month = feb,

day = "1",

doi = "10.1016/j.euo.2024.01.005",

language = "English",

journal = "EUROPEAN UROLOGY ONCOLOGY",

issn = "2588-9311",

}

Hensley, PJ, Labbate, C, Zganjar, A, Howard, J, Huelster, H, Durdin, T, Pham, J, Xiao, L, Pallauf, M, Lombardo, K, Glezerman, I, Singla, N, Raman, JD, Coleman, J, Spiess, PE, Margulis, V, Potretzke, AM & Matin, SF 2024, 'Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function', EUROPEAN UROLOGY ONCOLOGY. https://doi.org/10.1016/j.euo.2024.01.005

TY - JOUR

T1 - Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function

AU - Hensley, Patrick J

AU - Labbate, Craig

AU - Zganjar, Andrew

AU - Howard, Jeffrey

AU - Huelster, Heather

AU - Durdin, Trey

AU - Pham, Jonathan

AU - Xiao, Lianchun

AU - Pallauf, Maximilian

AU - Lombardo, Kara

AU - Glezerman, Ilya

AU - Singla, Nirmish

AU - Raman, Jay D

AU - Coleman, Jonathan

AU - Spiess, Philippe E

AU - Margulis, Vitaly

AU - Potretzke, Aaron M

AU - Matin, Surena F

N1 - Pallauf: Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria

PY - 2024/2/1

Y1 - 2024/2/1

N2 - BACKGROUND AND OBJECTIVE: The timing of perioperative nephrotoxic chemotherapy for upper tract urothelial carcinoma (UTUC) remains controversial and strongly depends on predicted platinum eligibility after radical nephroureterectomy (RNU). The study objective was to develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) following RNU.METHODS: This was a multi-institutional retrospective study of patients with UTUC treated with RNU from 2000 to 2020 at seven high-volume referral centers. Use of adjuvant chemotherapy was risk-stratified. Patients were retrospectively randomly allocated 2:1 to discovery and validation cohorts. Discovery data were used to identify independent factors associated with GFR at 1-3 mo after RNU on linear regression, and backward selection was applied for model construction. Accuracy was defined as the percentage of predicted eGFR results within 30% of the corresponding observed eGFR.KEY FINDINGS AND LIMITATIONS: We included 1100 patients, of whom 733 were in the discovery and 367 were in the validation cohort. Multivariable predictors of postoperative eGFR decline included advanced age (odds ratio [OR] -0.18, 95% confidence interval [CI] -0.28 to -0.08), diabetes (OR -2.38, 95% CI -4.64 to -0.11), and hypertension (OR -2.24, 95% CI -4.16 to -0.32). Factors associated with favorable postoperative eGFR included larger tumor size (OR 10.57, 95% CI 7.4-13.74 for tumors >5 cm vs ≤2 cm) and preoperative eGFR (OR 0.44, 95% CI 0.39-0.49). A composite nomogram predicted postoperative eGFR with good accuracy in both the discovery (80.5%) and validation (78.6%) cohorts. Limitations include exclusion of patients who received neoadjuvant chemotherapy.CONCLUSIONS: A nomogram that incorporates ubiquitous preoperative clinical variables can predict post-RNU eGFR and was validated with an independent cohort.PATIENT SUMMARY: We developed a tool that uses patient data to predict eligibility for chemotherapy after surgery to remove the kidney and ureter in patients with cancer in the upper urinary tract.

AB - BACKGROUND AND OBJECTIVE: The timing of perioperative nephrotoxic chemotherapy for upper tract urothelial carcinoma (UTUC) remains controversial and strongly depends on predicted platinum eligibility after radical nephroureterectomy (RNU). The study objective was to develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) following RNU.METHODS: This was a multi-institutional retrospective study of patients with UTUC treated with RNU from 2000 to 2020 at seven high-volume referral centers. Use of adjuvant chemotherapy was risk-stratified. Patients were retrospectively randomly allocated 2:1 to discovery and validation cohorts. Discovery data were used to identify independent factors associated with GFR at 1-3 mo after RNU on linear regression, and backward selection was applied for model construction. Accuracy was defined as the percentage of predicted eGFR results within 30% of the corresponding observed eGFR.KEY FINDINGS AND LIMITATIONS: We included 1100 patients, of whom 733 were in the discovery and 367 were in the validation cohort. Multivariable predictors of postoperative eGFR decline included advanced age (odds ratio [OR] -0.18, 95% confidence interval [CI] -0.28 to -0.08), diabetes (OR -2.38, 95% CI -4.64 to -0.11), and hypertension (OR -2.24, 95% CI -4.16 to -0.32). Factors associated with favorable postoperative eGFR included larger tumor size (OR 10.57, 95% CI 7.4-13.74 for tumors >5 cm vs ≤2 cm) and preoperative eGFR (OR 0.44, 95% CI 0.39-0.49). A composite nomogram predicted postoperative eGFR with good accuracy in both the discovery (80.5%) and validation (78.6%) cohorts. Limitations include exclusion of patients who received neoadjuvant chemotherapy.CONCLUSIONS: A nomogram that incorporates ubiquitous preoperative clinical variables can predict post-RNU eGFR and was validated with an independent cohort.PATIENT SUMMARY: We developed a tool that uses patient data to predict eligibility for chemotherapy after surgery to remove the kidney and ureter in patients with cancer in the upper urinary tract.

U2 - 10.1016/j.euo.2024.01.005

DO - 10.1016/j.euo.2024.01.005

M3 - Original Article

C2 - 38307832

SN - 2588-9311

JO - EUROPEAN UROLOGY ONCOLOGY

JF - EUROPEAN UROLOGY ONCOLOGY

ER -

Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function

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