AUTHOR=Pallauf Maximilian , König Frederik , D’Andrea David , Laukhtina Ekaterina , Mostafaei Hadi , Motlagh Reza Sari , Quhal Fahad , Aydh Abdulmajeed , Yanagisawa Takafumi , Kawada Tatsushi , Rajwa Pawel , Lusuardi Lukas , Soria Francesco , Karakiewicz Pierre I. , Rouprêt Morgan , Rink Michael , Lotan Yair , Margulis Vitaly , Singla Nirmish , Xylinas Evanguelos , Shariat Shahrokh F. , Pradere Benjamin 

TITLE=A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.907975

DOI=10.3389/fonc.2022.907975

ISSN=2234-943X

ABSTRACT=Background: Current guidelines recommend assessing the prognosis in high-risk upper tract urothelial carcinoma patients (UTUC). However, no specific method is endorsed. Among the various prognostic models, nomograms represent an easy and accurate tool to predict the individual probability for a specific event. Therefore, identifying the best-suited nomogram for each setting seems of great interest to the patient and provider.

Objectives: To identify, summarize and compare postoperative UTUC nomograms predicting oncologic outcomes. To estimate the overall performance of the nomograms and identify the most reliable predictors.

Design: A systematic review was conducted following the recommendations of Cochrane’s Prognosis Methods Group. Medline and EMBASE databases were searched for studies published before December 2021. Nomograms were grouped according to outcome measurements, the purpose of use, and inclusion and exclusion criteria. Random-effects meta-analyses were performed to estimate nomogram group performance and predictor reliability.

Results: The systematic review identified 26 nomograms. Only four were externally validated. Study heterogeneity was significant, and the overall Risk of Bias (RoB) was high. Nomogram groups predicting overall survival (OS), recurrence-free survival (RFS), and intravesical recurrence (IVR) had moderate discrimination accuracy (c-Index summary estimate with 95% confidence interval [95% CI] and prediction interval [PI] > 0.6). Nomogram groups predicting cancer-specific survival (CSS) had good discrimination accuracy (c-Index summary estimate with 95% CI and PI > 0.7). Advanced pathological tumor stage (≥ pT3) was the most reliable predictor of OS. Pathological tumor stage (≥ pT2), age, and lymphovascular invasion (LVI) were the most reliable predictors of CSS. LVI was the most reliable predictor of RFS.

Conclusions: Despite a moderate to good discrimination accuracy, postoperative prognostic UTUC nomograms have low generalizability for daily practice. For nomograms to become relevant for treatment decisions, future research must invest in their external validation and assessment of clinical utility.