Kang ZiMing, Wang Cheng, Xu WanRong, Zhang Biao, Wan JiangHou, Li HengPing, Shang PanFeng
Department of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu Province, China.
Department of Urology, Lanzhou University First Hospital, Lanzhou University, Lanzhou, Gansu Province, China.
Int Urol Nephrol. 2025 Mar 21. doi: 10.1007/s11255-025-04455-9.
To develop a prediction model for assessing the risk of postoperative metastasis in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) and to analyze independent risk factors for metastasis at different sites.
We retrospectively analyzed data from 555 UTUC patients who underwent RNU at 3 medical centers between January 2012 and August 2023. Patients were randomly divided into a training cohort (n = 388) and a validation cohort (n = 167) at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify postoperative metastasis risk factors. A nomogram was developed based on these factors and validated. In addition, independent risk factors for metastasis at different sites were analyzed.
Among the 555 patients, 122 (22.0%) developed postoperative metastasis. Middle and lower ureteral tumors, T stage ≥ T3, high-grade tumors, lymphovascular invasion (LVI), and a prognostic nutritional index (PNI) < 48.75 were associated with poorer metastasis-free survival (MFS). The nomogram achieved C-indexes of 0.816 and 0.812 in the training and validation cohorts. Age < 65 years was a risk factor for lymph node metastasis, tumor size and necrosis predicted liver metastasis, and a higher preoperative platelet-to-lymphocyte ratio (PLR) was associated with bone metastasis. Median overall survival (OS) for lymph node, lung, liver, multiple sites, bone, and brain metastasis were 14, 10, 6, 5.5, 5, and 4.5 months, respectively.
The prediction model developed effectively assesses postoperative metastasis risk in UTUC patients' aids in guiding individualized treatment. The risk factors for different metastasis sites are generally similar, with slight variations, which may offer new directions for future research on site-specific therapeutic strategies.
建立一种预测模型，用于评估上尿路尿路上皮癌（UTUC）患者根治性肾输尿管切除术（RNU）后发生术后转移的风险，并分析不同部位转移的独立危险因素。
我们回顾性分析了2012年1月至2023年8月期间在3个医学中心接受RNU的555例UTUC患者的数据。患者以7:3的比例随机分为训练队列（n = 388）和验证队列（n = 167）。在训练队列中进行单因素和多因素Cox回归分析，以确定术后转移的危险因素。基于这些因素建立了列线图并进行了验证。此外，还分析了不同部位转移的独立危险因素。
在555例患者中，122例（22.0%）发生了术后转移。输尿管中下段肿瘤、T分期≥T3、高级别肿瘤、淋巴管浸润（LVI）和预后营养指数（PNI）<48.75与无转移生存期（MFS）较差相关。列线图在训练队列和验证队列中的C指数分别为0.816和0.812。年龄<65岁是淋巴结转移的危险因素，肿瘤大小和坏死预测肝转移，术前较高的血小板与淋巴细胞比值（PLR）与骨转移相关。淋巴结、肺、肝、多部位、骨和脑转移患者的中位总生存期（OS）分别为14、10、6、5.5、5和4.5个月。
所建立的预测模型可有效评估UTUC患者的术后转移风险，有助于指导个体化治疗。不同转移部位的危险因素总体相似，但略有差异，这可能为未来针对特定部位治疗策略的研究提供新方向。
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