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A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery

BACKGROUND: Current guidelines recommend assessing the prognosis in high-risk upper tract urothelial carcinoma patients (UTUC) after surgery. However, no specific method is endorsed. Among the various prognostic models, nomograms represent an easy and accurate tool to predict the individual probabil...

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Autores principales: Pallauf, Maximilian, König, Frederik, D’Andrea, David, Laukhtina, Ekaterina, Mostafaei, Hadi, Motlagh, Reza Sari, Quhal, Fahad, Aydh, Abdulmajeed, Yanagisawa, Takafumi, Kawada, Tatsushi, Rajwa, Pawel, Lusuardi, Lukas, Soria, Francesco, Karakiewicz, Pierre I., Rouprêt, Morgan, Rink, Michael, Lotan, Yair, Margulis, Vitaly, Singla, Nirmish, Xylinas, Evanguelos, Shariat, Shahrokh F., Pradere, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283688/
https://www.ncbi.nlm.nih.gov/pubmed/35847838
http://dx.doi.org/10.3389/fonc.2022.907975
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author Pallauf, Maximilian
König, Frederik
D’Andrea, David
Laukhtina, Ekaterina
Mostafaei, Hadi
Motlagh, Reza Sari
Quhal, Fahad
Aydh, Abdulmajeed
Yanagisawa, Takafumi
Kawada, Tatsushi
Rajwa, Pawel
Lusuardi, Lukas
Soria, Francesco
Karakiewicz, Pierre I.
Rouprêt, Morgan
Rink, Michael
Lotan, Yair
Margulis, Vitaly
Singla, Nirmish
Xylinas, Evanguelos
Shariat, Shahrokh F.
Pradere, Benjamin
author_facet Pallauf, Maximilian
König, Frederik
D’Andrea, David
Laukhtina, Ekaterina
Mostafaei, Hadi
Motlagh, Reza Sari
Quhal, Fahad
Aydh, Abdulmajeed
Yanagisawa, Takafumi
Kawada, Tatsushi
Rajwa, Pawel
Lusuardi, Lukas
Soria, Francesco
Karakiewicz, Pierre I.
Rouprêt, Morgan
Rink, Michael
Lotan, Yair
Margulis, Vitaly
Singla, Nirmish
Xylinas, Evanguelos
Shariat, Shahrokh F.
Pradere, Benjamin
author_sort Pallauf, Maximilian
collection PubMed
description BACKGROUND: Current guidelines recommend assessing the prognosis in high-risk upper tract urothelial carcinoma patients (UTUC) after surgery. However, no specific method is endorsed. Among the various prognostic models, nomograms represent an easy and accurate tool to predict the individual probability for a specific event. Therefore, identifying the best-suited nomogram for each setting seems of great interest to the patient and provider. OBJECTIVES: To identify, summarize and compare postoperative UTUC nomograms predicting oncologic outcomes. To estimate the overall performance of the nomograms and identify the most reliable predictors. To create a reference tool for postoperative UTUC nomograms, physicians can use in clinical practice. DESIGN: A systematic review was conducted following the recommendations of Cochrane’s Prognosis Methods Group. Medline and EMBASE databases were searched for studies published before December 2021. Nomograms were grouped according to outcome measurements, the purpose of use, and inclusion and exclusion criteria. Random-effects meta-analyses were performed to estimate nomogram group performance and predictor reliability. Reference tables summarizing the nomograms’ important characteristics were created. RESULTS: The systematic review identified 26 nomograms. Only four were externally validated. Study heterogeneity was significant, and the overall Risk of Bias (RoB) was high. Nomogram groups predicting overall survival (OS), recurrence-free survival (RFS), and intravesical recurrence (IVR) had moderate discrimination accuracy (c-Index summary estimate with 95% confidence interval [95% CI] and prediction interval [PI] > 0.6). Nomogram groups predicting cancer-specific survival (CSS) had good discrimination accuracy (c-Index summary estimate with 95% CI and PI > 0.7). Advanced pathological tumor stage (≥ pT3) was the most reliable predictor of OS. Pathological tumor stage (≥ pT2), age, and lymphovascular invasion (LVI) were the most reliable predictors of CSS. LVI was the most reliable predictor of RFS. CONCLUSIONS: Despite a moderate to good discrimination accuracy, severe heterogeneity discourages the uninformed use of postoperative prognostic UTUC nomograms. For nomograms to become of value in a generalizable population, future research must invest in external validation and assessment of clinical utility. Meanwhile, this systematic review serves as a reference tool for physicians choosing nomograms based on individual needs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282596, identifier PROSPERO [CRD42021282596].
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spelling pubmed-92836882022-07-16 A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery Pallauf, Maximilian König, Frederik D’Andrea, David Laukhtina, Ekaterina Mostafaei, Hadi Motlagh, Reza Sari Quhal, Fahad Aydh, Abdulmajeed Yanagisawa, Takafumi Kawada, Tatsushi Rajwa, Pawel Lusuardi, Lukas Soria, Francesco Karakiewicz, Pierre I. Rouprêt, Morgan Rink, Michael Lotan, Yair Margulis, Vitaly Singla, Nirmish Xylinas, Evanguelos Shariat, Shahrokh F. Pradere, Benjamin Front Oncol Oncology BACKGROUND: Current guidelines recommend assessing the prognosis in high-risk upper tract urothelial carcinoma patients (UTUC) after surgery. However, no specific method is endorsed. Among the various prognostic models, nomograms represent an easy and accurate tool to predict the individual probability for a specific event. Therefore, identifying the best-suited nomogram for each setting seems of great interest to the patient and provider. OBJECTIVES: To identify, summarize and compare postoperative UTUC nomograms predicting oncologic outcomes. To estimate the overall performance of the nomograms and identify the most reliable predictors. To create a reference tool for postoperative UTUC nomograms, physicians can use in clinical practice. DESIGN: A systematic review was conducted following the recommendations of Cochrane’s Prognosis Methods Group. Medline and EMBASE databases were searched for studies published before December 2021. Nomograms were grouped according to outcome measurements, the purpose of use, and inclusion and exclusion criteria. Random-effects meta-analyses were performed to estimate nomogram group performance and predictor reliability. Reference tables summarizing the nomograms’ important characteristics were created. RESULTS: The systematic review identified 26 nomograms. Only four were externally validated. Study heterogeneity was significant, and the overall Risk of Bias (RoB) was high. Nomogram groups predicting overall survival (OS), recurrence-free survival (RFS), and intravesical recurrence (IVR) had moderate discrimination accuracy (c-Index summary estimate with 95% confidence interval [95% CI] and prediction interval [PI] > 0.6). Nomogram groups predicting cancer-specific survival (CSS) had good discrimination accuracy (c-Index summary estimate with 95% CI and PI > 0.7). Advanced pathological tumor stage (≥ pT3) was the most reliable predictor of OS. Pathological tumor stage (≥ pT2), age, and lymphovascular invasion (LVI) were the most reliable predictors of CSS. LVI was the most reliable predictor of RFS. CONCLUSIONS: Despite a moderate to good discrimination accuracy, severe heterogeneity discourages the uninformed use of postoperative prognostic UTUC nomograms. For nomograms to become of value in a generalizable population, future research must invest in external validation and assessment of clinical utility. Meanwhile, this systematic review serves as a reference tool for physicians choosing nomograms based on individual needs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282596, identifier PROSPERO [CRD42021282596]. Frontiers Media S.A. 2022-07-01 /pmc/articles/PMC9283688/ /pubmed/35847838 http://dx.doi.org/10.3389/fonc.2022.907975 Text en Copyright © 2022 Pallauf, König, D’Andrea, Laukhtina, Mostafaei, Motlagh, Quhal, Aydh, Yanagisawa, Kawada, Rajwa, Lusuardi, Soria, Karakiewicz, Rouprêt, Rink, Lotan, Margulis, Singla, Xylinas, Shariat and Pradere https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Pallauf, Maximilian
König, Frederik
D’Andrea, David
Laukhtina, Ekaterina
Mostafaei, Hadi
Motlagh, Reza Sari
Quhal, Fahad
Aydh, Abdulmajeed
Yanagisawa, Takafumi
Kawada, Tatsushi
Rajwa, Pawel
Lusuardi, Lukas
Soria, Francesco
Karakiewicz, Pierre I.
Rouprêt, Morgan
Rink, Michael
Lotan, Yair
Margulis, Vitaly
Singla, Nirmish
Xylinas, Evanguelos
Shariat, Shahrokh F.
Pradere, Benjamin
A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery
title A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery
title_full A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery
title_fullStr A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery
title_full_unstemmed A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery
title_short A Systematic Review and Meta-Analysis of Prognostic Nomograms After UTUC Surgery
title_sort systematic review and meta-analysis of prognostic nomograms after utuc surgery
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283688/
https://www.ncbi.nlm.nih.gov/pubmed/35847838
http://dx.doi.org/10.3389/fonc.2022.907975
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