Background: There are difffferences in survival between high-and low-grade Upper Tract Urothelial Carcinoma (UTUC). Our study aimed to develop a nomogram to predict overall survival (OS) of patients with high- and low- grade UTUC after tumor resection, and to explore the difffference between high-and low-grade patients.
Methods: Patients confifirmed to have UTUC between 2004 and 2015 were selected from the Surveillance, Epidemiology and End Results (SEER) database. The UTUCs were identifified and classifified as high- and low-grade, and 1-, 3-and 5-year nomograms were established. The nomogram was then validated using the Chinese multicenter dataset (patients diagnosed in Shandong, China between January 2010 and October 2020).
Findings: In the high-grade UTUC patients, nine important factors related to survival after tumor resection were identifified to construct nomogram. The ability of the model to distinguish between UTUC grades was verifified using two datasets (internal validation dataset, C index(95% CI):0.729[0.707-0.754];Chinese multicenter validation dataset: C index(95% CI):0.763[0.656-0.869]).On the other hand, Two independent predictors were identifified to construct nomogram of low-grade UTUC. The C index was 0.714 (95% CI: 0.671-0.758) for the training set,0.731(95% CI:0.670-0.791) for the internal validation dataset, and 0.825 (95% CI:0.689-1.00) for the Chinese multicenter dataset. Encouragingly, the nomogram was clinically useful and had a good discriminative ability to identify patients at high risk.
Interpretation: We constructed a nomogram and a corresponding risk classifification system predicting the OS of patients with an initial diagnosis of high-and low-grade UTUC.