A Nomogram for Predicting Renal Insufficiency in UTUC After Radical Nephroureterectomy - Expert Commentary
Post-operative adjuvant cisplatin-based chemotherapy (AC) is only possible in a small subset of patients without renal dysfunction, which is evaluated using the estimated glomerular filtration rate (eGFR). Hensley et al. developed a nomogram to predict post-RNU eGFR to facilitate patient-driven treatment selection.
The study cohort included 1100 patients undergoing RNU for UTUC across various centers in the U.S. The cohort was divided into discovery (n = 733) and validation (n = 367) cohorts. The median preoperative eGFR was 60 mL/min/1.73 m2, which is the cutoff for AC eligibility. However, the median eGFR was 44 mL/min/1.73 m2 at 1-3 months after RNU and 45 mL/min/1.73 m2 at 12 months. In a multivariable analysis, significant predictors of postoperative eGFR decline were age (OR, 0.18, 95% CI, -0.28 to -0.08), diabetes mellitus (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 less postoperative renal insufficiency were larger tumor size (OR, 10.57; 95% CI, 7.4–13.74 for size > 5 cm), and preoperative eGFR (OR, 0.44; 95% CI, 0.39–0.49). The investigators subsequently used the identified significant factors to develop the nomogram. Upon testing, the nomogram exhibited good accuracy in predicting postoperative eGFR in the discovery (R = 0.68; 95% CI, 0.63–0.72; 80.5% accuracy) and validation (R = 0.66; 95% CI, 0.59–0.72; 78.6% accuracy) cohorts.
The high performance of the nomogram confirms its validity as a tool that can be used to predict post-nephrectomy renal function and thus enhance patient selection for perioperative chemotherapy.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
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