Development And Validation Of A Model For Predicting Intravesical Recurrence In Upper Urinary Tract Urothelial Carcinoma Patients After Radical Nephroureterectomy

Objective: Although radical nephroureterectomy is the standard treatment method for upper urinary tract urothelial carcinoma,it is associated with a high risk of intravesical recurrence.There are no models for predicting IVR after RNU in patients with organ-confined UTUC.Therefore,we developed and validated a model for postoperative prediction of IVR after RNU.Methods: The cohort consisted of 640 patients who underwent RNU with bladder cuff excision at our center between 1 January 2008 and 31 December 2018.Patient clinicopathologic data were recorded.Multivariate Cox proportional hazard ratio regression was used to build a predictive model with regression coefficients,backward step-wise selection was applied,and the likelihood ratio test with Akaike’s information criterion was used as the stopping rule.The performance of this predictive model was assessed with respect to discrimination,calibration,and clinical usefulness.Results: The predictors in this model included tumor stage,tumor diameter,tumor location,and tumor grade.In the validation cohort,the model showed good discrimination,with a concordance index of 0.689(95% CI,0.629 to 0.748)and good calibration.Decision curve analysis demonstrated that the model was also clinically useful.Conclusion: This study presents a good model that may facilitate individualized postoperative prediction of IVR after RNU in patients with organ-confined UTUC,and thus,may help improve postoperative strategies and facilitate treatment outcomes.