External validation of an online nomogram in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma

• Published in: British journal of cancer 2013-09, Vol.109 (5), p.1130-1136
• Main Authors: Ku, J H, Moon, K C, Jung, J H, Jeong, S H, Kwak, C, Kim, H H
• Format: Article
• Language: English
• Subjects: 692/699/67/589; 692/700/565/545/546; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Calibration; Cancer; Cancer Research; Chemotherapy; Clinical Study; Collaboration; Data Interpretation, Statistical; Decision making; Decision Support Techniques; Discrimination; Drug Resistance; Epidemiology; Female; Humans; Internet; Kaplan-Meier Estimate; Male; Medical prognosis; Medical sciences; Middle Aged; Molecular Medicine; Mortality; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Nephrectomy; Nephrology. Urinary tract diseases; Nomograms; Oncology; Pathology; Patients; Prognosis; Survival; Tumors; Tumors of the urinary system; Ureter - pathology; Ureter - surgery; Urinary tract; Urinary tract. Prostate gland; Urogenital system; Urologic Neoplasms - mortality; Urologic Neoplasms - surgery; Urothelial carcinoma; Urothelium - pathology; Young Adult
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2013.462

Background: The objective was to validate an online nomogram developed based on the French collaborative national database on upper urinary tract urothelial carcinoma (UUT-UC) using a different cohort. Methods: The study comprised 328 patients with UUT-UC who underwent radical nephroureterectomy. The discrimination of models was quantified using Harrell’s concordance index. The relationship between the model-derived and actuarial cancer-specific mortality was graphically explored within calibration plots. Calibration was also assessed using the quartiles of the predicted survival at 3 and 5 years and calculation of the corresponding observed Kaplan–Meier estimates. Clinical net benefit was evaluated constructing decision curve analysis. Results: The discrimination accuracy of the nomograms at 3 and 5 years was 71.6% and 71.8%, respectively. Although nomograms discriminated well by Kaplan–Meier curves, and log-rank tests were all highly significant, the calibration plots tended to exaggerate the overestimation of mortality between predicted and observed probabilities at 3 and 5 years for survival. When compared with the AJCC/UICC staging system, the nomograms performed well across a wide range of threshold probabilities using decision curve analysis. Conclusion: The online nomogram is a highly accurate prognostic tool for patients with UUT-UC treated with radical nephroureterectomy. The model can provide an accurate estimate of the individual risk of cancer-specific mortality. Further improvement and implementation of novel molecular marker is needed.