Discussion
non-metastatic UTUC, comorbidity, ’ OS, UTUC, squamous and sarcomatoid, urothelial carcinoma, high-grade
UROTHELIAL CARCINOMA
Nowadays, the AJCC-TNM staging system is a common tool for predicting OS in UTUC patients [Our study showed that patients who received chemotherapy had higher grade and TNM stage than patients who did not. This is consistent with the founding of other scholars [Our research indicated that age, TNM stage, marital status, and surgical methods of the primary site were independent prognostic factors for OS of UTUC patients treated with chemotherapy. Our nomogram was developed based on these prognostic factors to predict OS at 1, 3, and 5 years. The nomogram shows good prognostic ability and reliability. ROC and DCA curves showed our nomograms exhibited larger benefits than the 8th AJCC-TNM staging system. The results were consistent in both the training set and the internal validation set. However, Wang, M. suggested the use of AJCC TNM staging may better guide clinical decisions when predicting prognosis in high-grade patients [Several nomograms have been established to predict the prognosis of UTUC patients. Wu J et al. established a nomogram based on the SEER database, in which the gender, age, marital status, histology, seer stage, grade, surgery, radiotherapy, and chemotherapy were identified as prognostic factors for patients’ OS [One further strength lies in the following aspect. Surgical methods were incorporated into our nomogram for predicting the OS of UTUC patients. We built a nomogram based on age, marital status, TNM stage, and surgical methods of the primary site to predict the OS of UTUC patients who received chemotherapy. Surgical methods of the primary site were as follows: local Mass resection/destruction, radical nephroureterectomy, partial nephrectomy/ureterectomy, and radical nephrectomy. Open radical nephroureterectomy with bladder cuff excision is the standard treatment for high-risk non-metastatic UTUC [UTUC with histological variants were excluded from our study such as squamous and sarcomatoid variants. Histological variants of urothelial carcinoma are relatively rare, with approximately 25% of UTUC containing variant histology. Variant histology was associated with higher grades and poorer oncological outcomes [Our study had certain drawbacks. First, our study was a retrospective research design and selection bias inevitably existed. Second, the SEER database is short of detailed information about specific chemotherapy regimens, comorbidity and renal function. The latter emerges as an important factor influencing whether patients receive chemotherapy and its efficacy. Third, our nomograms should be externally validated for prediction capacity by large cohorts. Moreover, since more that 10% of UTUC patients had concomitant bladder cancer [