Mp69-11 predictive nomogram for post-nephroureterectomy gfr estimation

You have accessJournal of UrologyCME1 Apr 2023MP69-11 PREDICTIVE NOMOGRAM FOR POST-NEPHROURETERECTOMY GFR ESTIMATION Patrick Hensley, Craig Labbate, Lianchun Xiao, Andrew Zganjar, Trey Durdin, Heather Huelster, Jonathan Pham, Jeffrey Howard, Maximilian Pallauf, Kara Lombardo, Aaron Potretzke, Philippe Spiess, Jay Raman, Vitaly Margulis, Nirmish Singla, Jonathan Coleman, and Surena Matin Patrick HensleyPatrick Hensley More articles by this author , Craig LabbateCraig Labbate More articles by this author , Lianchun XiaoLianchun Xiao More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , Trey DurdinTrey Durdin More articles by this author , Heather HuelsterHeather Huelster More articles by this author , Jonathan PhamJonathan Pham More articles by this author , Jeffrey HowardJeffrey Howard More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Kara LombardoKara Lombardo More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Jay RamanJay Raman More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Nirmish SinglaNirmish Singla More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , and Surena MatinSurena Matin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephrotoxicity from platinum-based neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma (UTUC) must be considered in the context of definitive surgical timing. We developed a predictive nomogram for eGFR estimation after radical nephroureterectomy (RNU) using a multi-institutional cohort to aid with decisions regarding sequencing of nephrotoxic chemotherapy before or after surgery. METHODS: Patients undergoing RNU for UTUC from 2000-2020 were included. Patients with solitary kidney, prior cystectomy, or neoadjuvant chemotherapy were excluded. eGFR values were normalized using the CKD-EPI equation. Patients were randomly allocated 2:1 into test and validation sets. Test data were used to identify covariates independently associated with eGFR 1-3 months after RNU using univariable linear regression. Backward selection was applied for model construction, including all variables with p<0.05 on multivariable linear regression in the nomogram. The nomogram was then subjected to validation. Pearson coefficients assessed correlation between observed and predicted post-RNU eGFR. RESULTS: 1095 patients were included in analysis. Median eGFR pre-operatively and 1-3 months post-RNU was 60.0 and 43.3mL/min/1.73m2, respectively. Significant independent predictors of eGFR post-RNU in the test cohort included age (-0.28, 95% CI -0.37;-0.19), diabetes (-2.53, 95% CI -4.61;-0.46), tumor size (1.02, 95% CI 0.58;1.46) and pre-RNU eGFR (0.4, 95% CI 0.35;0.45). The nomogram (Figure 1) exhibited R=0.71 (95% CI 0.65,0.76; Figure 2) in the validation set with 80% accuracy (% predicted eGFR values within 30% of observed). CONCLUSIONS: We generated a nomogram to predict post-RNU renal function with moderate accuracy using independent predictors of eGFR change after RNU. These data can be used in patient counseling to better personalize the sequencing of nephrotoxic chemotherapy in the neoadjuvant and adjuvant settings in a risk-stratified approach. Source of Funding: Urology Care Foundation Research Scholars Award to PJH (IRG 85-001-25), Monteleone Family Foundation for Research in Bladder and Kidney Cancer and the Eleanor and Scott Petty Fund for Upper Tract Urothelial Carcinoma Research (SFM) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e968 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Hensley More articles by this author Craig Labbate More articles by this author Lianchun Xiao More articles by this author Andrew Zganjar More articles by this author Trey Durdin More articles by this author Heather Huelster More articles by this author Jonathan Pham More articles by this author Jeffrey Howard More articles by this author Maximilian Pallauf More articles by this author Kara Lombardo More articles by this author Aaron Potretzke More articles by this author Philippe Spiess More articles by this author Jay Raman More articles by this author Vitaly Margulis More articles by this author Nirmish Singla More articles by this author Jonathan Coleman More articles by this author Surena Matin More articles by this author Expand All Advertisement PDF downloadLoading ...