Development and internal validation of a nomogram to predict five-years significant CKD upstaging after robot-assisted partial nephrectomy

You have accessJournal of UrologyCME1 Apr 2023PD07-02 DEVELOPMENT AND INTERNAL VALIDATION OF A NOMOGRAM TO PREDICT FIVE-YEARS SIGNIFICANT CKD UPSTAGING AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY Rocco Simone Flammia, Umberto Anceschi, Aldo Brassetti, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Antonio Tufano, Costantino Leonardo, Michele Gallucci, Porpiglia Francesco, Daniele Amparore, Andrea Minervini, Andrea Mari, Andre Antonio Grasso, Riccardo Autorino, Daniel Eun, Alessandro Larcher, Umberto Capitanio, and Giuseppe Simone Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Antonio TufanoAntonio Tufano More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Porpiglia FrancescoPorpiglia Francesco More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Andrea MariAndrea Mari More articles by this author , Andre Antonio GrassoAndre Antonio Grasso More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Daniel EunDaniel Eun More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To date, Martini nomogram represents the best attempt to stratify the risk of renal function decline in patients treated with robot-assisted partial nephrectomy (RAPN) for kidney tumor. However, this tool relied on short follow-up and adopted a questionable endpoint such as 25% eGFR reduction. To address this void, we developed a novel nomogram to accurately predict the risk of 5-years CKD upstaging in patients treated with RAPN. Moreover, we aimed at stratifying patients in different risk categories based nomogram-derived probability. METHODS: Whitin a multi-institutional database, we identified patients treated with RAPN for localized renal tumor (cT1-2, cN0, cM0). Exclusion criteria was end-stage renal disease. Kaplan-Meier and Cox Regression addressed significant CKD upstaging (sCKD-upstaging), defined as any upstaging to CKD≥3a. The predictive model was built as follow: 1) univariable Cox regression analysis excluded non-significant predictors (p≥0.05); 2) predictors were checked for multicollinearity; 3) stepwise bidirectional Cox regression analysis identified the best model. Model accuracy was reported as Harrel C-index. Internal validation (bootstrapping) and calibration were performed. Nomogram predicting 5-years sCKD-upstaging risk was displayed. Regression tree analysis identified potential cut-offs in nomogram-derived probability. Based on this cut-offs, three risk class were derived and tested with Kaplan-Meier analysys (log-rank test). RESULTS: Overall, 965 patients were identified. At Kaplan-Meier analysis 5-years sCKD-upstaging free-survival was 69.1% (95%CI 64.8-73.7%). The final model included baseline eGFR, postoperative AKI, WIT, hypertension, age at surgery, solitary kidney status and multiple lesions. Model accurately predicted 5-years sCKD-upstaging (C-index 83.3%). Two nomogram cut-off (16 and 37%) were identified. Based on this cut-off, the overall cohort was stratified in three risk categories (low:<16% vs intermediate:16-37% vs high:>37%). Kaplan-Meier analysis depicted a significant reduction in five-years sCKD-upstaging free survival rates between low vs intermediate vs high-risk (97.0% vs 71.9% vs 32.2%, respectevely, p<0.001). CONCLUSIONS: We developed a novel nomogram that accurately predicted five-years significant CKD-upstaging. Moreover, we were able to identify three subgroups with substantial difference in risk profiles. If externally validated this nomogram may represent a useful tool to improve patient counselling and management. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e161 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rocco Simone Flammia More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Riccardo Mastroianni More articles by this author Leonardo Misuraca More articles by this author Gabriele Tuderti More articles by this author Antonio Tufano More articles by this author Costantino Leonardo More articles by this author Michele Gallucci More articles by this author Porpiglia Francesco More articles by this author Daniele Amparore More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Andre Antonio Grasso More articles by this author Riccardo Autorino More articles by this author Daniel Eun More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...