Nomogram for predicting acute kidney disease in patients with upper tract urothelial carcinoma undergoing adjuvant chemotherapy following radical nephroureterectomy.
Radical nephroureterectomy (RNU) with complete bladder cuff excision is the primary treatment for high-risk non-metastatic upper urinary tract urothelial carcinoma (UTUC). Gemcitabine-platinum combination chemotherapy is established as the preferred adjuvant therapy post-RNU; however, both RNU and platinum-based therapies can significantly impair renal function. This study aimed to construct a nomogram to predict acute kidney disease (AKD) occurrence in UTUC patients undergoing gemcitabine-platinum chemotherapy after RNU.
We collected data from patients who underwent RNU followed by adjuvant gemcitabine-platinum chemotherapy at Beijing Friendship Hospital, Capital Medical University, between September 2015 and September 2024. Demographic, perioperative, and pre-chemotherapy data were analyzed. After rigorous screening, 126 patients were included and randomly allocated to a development cohort (n=88, 70%) and a validation cohort (n=38, 30%) in a 7:3 ratio. Risk factors for AKD identified by univariate and backward stepwise multivariate logistic regression analyses were used to develop the nomogram. Its performance was assessed using calibration curves, Harrell's concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) analysis.
AKD occurred in 31 patients (24.6%). Multivariate logistic regression identified five significant independent predictors: age (P=0.04), diabetes mellitus (P=0.03), proteinuria (P=0.003), serum creatinine before chemotherapy (P=0.002), and postoperative acute kidney injury (AKI) (P=0.01). The nomogram demonstrated strong discriminatory power, with an area under the curve (AUC) of 0.895 [95% confidence interval (CI): 0.825-0.964] in the development cohort and 0.893 (95% CI: 0.776-1.000) in the validation cohort. DCA and CIC indicated good clinical utility.
Age, diabetes mellitus, preoperative proteinuria, serum creatinine before chemotherapy, and postoperative AKI are significant risk factors for AKD in UTUC patients receiving gemcitabine-platinum chemotherapy after RNU. The developed nomogram serves as an effective predictive tool for AKD in this population.
We collected data from patients who underwent RNU followed by adjuvant gemcitabine-platinum chemotherapy at Beijing Friendship Hospital, Capital Medical University, between September 2015 and September 2024. Demographic, perioperative, and pre-chemotherapy data were analyzed. After rigorous screening, 126 patients were included and randomly allocated to a development cohort (n=88, 70%) and a validation cohort (n=38, 30%) in a 7:3 ratio. Risk factors for AKD identified by univariate and backward stepwise multivariate logistic regression analyses were used to develop the nomogram. Its performance was assessed using calibration curves, Harrell's concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) analysis.
AKD occurred in 31 patients (24.6%). Multivariate logistic regression identified five significant independent predictors: age (P=0.04), diabetes mellitus (P=0.03), proteinuria (P=0.003), serum creatinine before chemotherapy (P=0.002), and postoperative acute kidney injury (AKI) (P=0.01). The nomogram demonstrated strong discriminatory power, with an area under the curve (AUC) of 0.895 [95% confidence interval (CI): 0.825-0.964] in the development cohort and 0.893 (95% CI: 0.776-1.000) in the validation cohort. DCA and CIC indicated good clinical utility.
Age, diabetes mellitus, preoperative proteinuria, serum creatinine before chemotherapy, and postoperative AKI are significant risk factors for AKD in UTUC patients receiving gemcitabine-platinum chemotherapy after RNU. The developed nomogram serves as an effective predictive tool for AKD in this population.