External Validation of Pre-Operative Nomogram for Prediction of Non-Organ Confined Upper Urinary Tract Urothelial Carcinoma in Central Taiwan Population
Liang-Wei Chiu, Jen-Kai Fang, Chi-Ping Huang, Chao-Hsiang Chang, Chi-Rei Yang, Hsi-Chin Wu, Chin-Chung Yeh, Wen-Chi Chen, Po-Fan Hsieh, Chi-Shun Lien, Guan-Heng Chen, Po-Jen Hsiao, Yi-Huei Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Introduction: According to National Comprefensive Cancer Network (NCCN) guideline, if no platinum neoadjuvant treatment given to non-organ confined (NOC) upper urinary tract urothelial carcinoma (UTUC) (pT3/pT4 and/or pN+), adjuvant platinum-based chemotherapy should be considered. But, as the renal function is declined after nephroureterectomy with bladder cuff excision (NUBCE), the adjuvant chemotherapy may be precluded. Therefore, it is important to make a good preoperative risk stratification of UTUC. In 2019, Firas G. Petros et al proposed a nomogram for prediction of NOC-UTUC. The nomogram was composed of biopsy grade, architecture, hemoglobin (Hb) and clinical tumor stage. High accuracy up to 82% was claimed. However, the applicability to non-western area is not sure. The aim of this study is to find out the applicability of this nomogram in Central Taiwan population.
Materials and Methods: From November 2011 to August 2019, we recruited 288 patients with UTUC undergoing preoperative endoscopic biopsy and NUBCE in China Medical University Hospital. Each patient had the total points according to the nomogram published by Firas G. Petros with the cut off value of 122. We analyzed the accuracy, sensitivity and specificity of the nomogram in our cases.
Results: Among the 288 patients, 113 patients (39.2%) were diagnosed of NOC-UTUC. The nomogram in our cases had 61.5% accuracy, 46.0% sensitivity, 71.4% specificity in predicting NOC-UTUC. Compared to the results of the original study, 82% accuracy, 48% sensitivity, and 95% specificity, this nomogram has lower accuracy, and lower specificity in Central Taiwan population. The sensitivity is similar to the original study.
Conclusions: This preoperative multiplex is a simple and accurate preoperative tool for the prediction of NOC-UTUC in western area. However, it may not be applicable to Central Taiwan population. We should create a nomogram from the data of patients with UTUC in Taiwan.