Novel Nomogram Predicts Lymph Node Invasion in UTUC

New research by Cesare Saitta, MD, and colleagues detailed the development of a novel nomogram to predict lymph node invasion in patients with upper tract urothelial carcinoma (UTUC). Their study was presented at the European Association of Urology Congress 2024.

The nomogram is used preoperatively to determine the probability of nodal tropism (NT), defined as node invasion (NI) upon histological report or presence of node metastasis (NM) upon follow-up.

NI was defined as the presence of positive nodes at final histological report, and NM was defined as the emergence of newly detected retroperitoneal lymphadenopathy (>10 mm) during the follow-up period.

Researchers used the ROBUUST database to analyze 1117 patients with UTUC who underwent robotic nephroureterectomy. Independent predictors for NT included multivariable logistic regression cN+ (odds ratio [OR], 8.19; P<.001),  cT4 versus cTa (OR, 10.38; P=.012), history of bladder cancer (OR, 6.66; P<.001), high-grade cytology (OR, 2.90; P<.001), platelet-lymphocyte ratio ≥130 (OR, 1.77; P=.021), diabetes mellitus (OR, 1.90; P=.023), and symptoms at diagnosis (OR, 2.16; P=.008).

The area under the curve (AUC) of the model was 0.83, while the AUC after internal validation was 0.81 (95% CI, 0.76-0.87). A 7.0% threshold probability demonstrated 80.2% sensitivity, 75.4% specificity, and a 97.5% negative predictive value.

Further research is needed to validate utility with respect to the performance of lymphadenectomy at the time of surgery, post-surgical monitoring, and refinement of patient selection for adjuvant and neoadjuvant therapy.