Researchers in China have developed a predictive tool, or nomogram, to assess the risk of bladder cancer recurrence in patients following upper tract urothelial carcinoma (UTUC) surgery. The model, which incorporates tumor stage and grade as well as preoperative ureteroscopy, showed strong predictive performance in a recent study.
Previous research has shown that many patients undergoing radical nephroureterectomy with bladder cuff excision for UTUC experience bladder cancer recurrence during follow-up.
In the new study, Xin Li and colleagues retrospectively analyzed 292 UTUC patients, dividing them into a training set and an internal validation set to develop the nomogram. They identified four independent risk factors for postoperative bladder cancer recurrence: tumor stage T3-T4, tumor grade G3, history of bladder cancer, and preoperative ureteroscopy.
The researchers reported that patients with T3-T4 tumors had a 4.5-fold higher risk of recurrence compared with T1-T2 tumors, while those with G3 grade tumors had a 4.9-fold higher risk compared with G1-G2 tumors. Preventive bladder perfusion appeared to reduce recurrence risk. Other factors—including sex, age, smoking status, diabetes, tumor size and location, lymph node metastasis, surgical method, and tumor laterality—were not significantly associated with recurrence.
The nomogram demonstrated high predictive accuracy. The area under the curve (AUC) for the training set was 0.864 and 0.831 for the internal validation set. Calibration curves confirmed the model’s reliability, and decision curve analysis showed it could provide substantial clinical benefit. At an optimal cutoff value of 54%, the model could identify 11 additional at-risk patients per 100 without increasing harm.
External validation further supported the model’s potential clinical utility, with an AUC of 0.847. The findings suggest that this nomogram could serve as a valuable tool for guiding postoperative management and intervention strategies in UTUC patients.
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