Background:

To develop a novel nomogram to improve the preoperative diagnosis of pathological grade of upper tract urothelial carcinoma (UTUC).

Methods:

Retrospective study was conducted with 245 patients with UTUC treated by radical nephroureterectomy from 2002 to 2016. Of the cohort, 57.6% received ureteroscopic (URS) biopsy and 35.9% received urine cytology examination. Preoperative clinical characteristics and examination results were collected. Final pathological grade was diagnosed by postoperative pathology. Univariable and multivariable binary logistic regressions were applied to establish a preoperative predictive model for tumor grade, and significant factors were included in the nomogram. The area under curve (AUC) was used to show the predictive efficacy, and the calibration plot was drawn for validation.

Results:

Of the 245 patients, 72.7% were diagnosed with pathological high-grade disease. Age (odds ratio [OR] = 1.03, P = .039), sessile (OR = 3.86, P = .021), positive urinary cytology (OR = 6.87, P = .035), and biopsy high-grade result (OR = 10.85, P < .001) were independent predictors for pathological high-grade disease. The predictive nomogram containing these factors achieved an AUC of 0.78, which was significantly better than URS biopsy alone (AUC = 0.62, P = .003) in the whole cohort. In the URS biopsy subgroup, the nomogram achieved an AUC of 0.79, better than biopsy alone (AUC = 0.76), but was not statistically significant (P = .431). When the cutoff value of the nomogram was set at 0.64, the sensitivity of detecting a high-grade lesion versus low-grade lesion was 80.3%, better than that of URS biopsy alone (sensitivity = 65.7%).

Conclusions:

Advanced age, sessile, positive urinary cytology, and biopsy high-grade were independent predictors of pathological high-grade disease in patients with UTUC. A nomogram containing these factors can improve diagnostic accuracy, potentially reducing the risk of “undergrading” by URS biopsy.

中文翻译：

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上尿路上皮癌术前风险分层病理分级诊断列线图

背景：

开发一种新的列线图，以提高上尿路尿路上皮癌（UTUC）病理分级的术前诊断。

方法：

对 2002 年至 2016 年接受根治性肾输尿管切除术治疗的 245 例 UTUC 患者进行了回顾性研究。在该队列中，57.6% 接受了输尿管镜 (URS) 活检，35.9% 接受了尿细胞学检查。收集术前临床特征和检查结果。最终病理分级由术后病理诊断。应用单变量和多变量二元逻辑回归建立术前肿瘤分级预测模型，列线图中包含显着因素。曲线下面积（AUC）用于显示预测效果，并绘制校准图进行验证。

结果：

245例患者中，72.7%被诊断为病理性高级别疾病。年龄（优势比 [OR] = 1.03，P  = .039），无柄（OR = 3.86，P  = .021），尿细胞学阳性（OR = 6.87，P  = .035）和活检高级别结果（OR = 10.85, P  < .001) 是病理性高级别疾病的独立预测因子。 包含这些因素的预测列线图的 AUC 为 0.78，在整个队列中明显优于单独的 URS 活检（AUC = 0.62，P = .003）。在 URS 活检亚组中，列线图的 AUC 为 0.79，优于单独活检（AUC = 0.76），但无统计学意义（P = .431)。当列线图的截止值设置为 0.64 时，检测高级别病变与低级别病变的灵敏度为 80.3%，优于单独的 URS 活检（灵敏度 = 65.7%）。

结论：

高龄、无蒂、阳性尿细胞学和高级别活检​​是 UTUC 患者病理高级别疾病的独立预测因素。包含这些因素的列线图可以提高诊断准确性，从而可能降低 URS 活检“分级”的风险。