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

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Timing of perioperative chemotherapy for upper tract urothelial carcinoma (UTUC) is debated.
• Chemotherapy eligibility depends on predicted kidney function after radical nephroureterectomy (RNU).

Purpose of the Study:

• Develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) after RNU.
• Provide a tool to aid in chemotherapy decision-making for UTUC patients.

Main Methods:

• Multi-institutional retrospective study of 1100 UTUC patients undergoing RNU.
• Patients randomly allocated to discovery (n=733) and validation (n=367) cohorts.
• Linear regression and backward selection used to identify predictors of postoperative eGFR.

Main Results:

• Predictors of eGFR decline included advanced age, diabetes, and hypertension.
• Favorable postoperative eGFR associated with larger tumor size and higher preoperative eGFR.
• The nomogram predicted postoperative eGFR with 80.5% accuracy in the discovery and 78.6% in the validation cohort.

Conclusions:

• A validated nomogram using preoperative clinical variables can predict post-RNU eGFR.
• This tool can assist in determining platinum-based chemotherapy eligibility for UTUC patients.