Development and validation of a nomogram for urothelial cancer in patients with chronic kidney disease

Chia-Chu Chang,Che-Yi Chou,Kuo-Hsiung Shu,Chien-Lung Chen,Hung-Chun Chen,Chiu-Ching Huang,Ming-Chang Wang,Bang-Gee Hsu,Tzen-Wen Chen

doi:10.1038/s41598-019-40276-4

Abstract

Urothelial cancer (UC) is a common kidney cancer in Taiwan and patients with chronic kidney disease (CKD) are more at risk for UC than the general population. The diagnostic value of urine analysis and urine cytology is limited, especially in CKD patients. The aim of the study is to develop a nomogram to predict the risk of UC in CKD patients. We enrolled 169 UC patients and 1383 CKD patients from 9 hospitals in Taiwan between 2012 and 2015. CA125, HE4, clinical characteristics, and medical history were analyzed using multivariable logistic regression for its association with UC. A nomogram was developed to predict the risk of UC and was validated using Bootstrap. CA125 was associated with UC in CKD patients (OR: 5.91, 95% CI: 3.24–10.77) but HE4 was not (OR: 1.29, 95% CI: 0.67–2.35). A nomogram based on patients’ age, estimated glomerular filtration rate, CA125 (log transformed), smoking, exposure of environmental toxin, use of nonsteroid anti-inflammatory drugs, and use of traditional Chinese medicine was conducted. The AUC of the nomogram was 0.90 (95% CI: 0.86–0.92, p < 0.01). Serum CA125 may identify UC patients from CKD patients but has limited diagnostic value due to low sensitivity. The diagnostic value of serum CA125 level can be improved by the combination with clinical characteristics including age, renal function, and medical history.

Highlights

Urothelial carcinoma (UC) is common cancer in chronic kidney disease (CKD) patients[1]
For Urothelial cancer (UC) patients, blood and urine samples were collected before surgical interventions
One hundred and sixty-nine UC patients and 1383 CKD patients were analyzed in this study (Fig. 1 and Table 1)

Summary

Introduction

Urothelial carcinoma (UC) is common cancer in chronic kidney disease (CKD) patients[1]. The development of UC can be associated with multiple factors such as smoking[5], drinking groundwater that contains heavy metals[6], exposures to environmental toxins such as dye[7] or organic solvent[8], and Chinese herbs that contain aristolochic acid (AA). Urinalysis and urine cytology are the major screening tools in a clinical setting; the diagnostic performance of these tests are poor[16,17]. Serum markers such as Carcinoma antigen (CA125)[18,19,20,21,22] and human epididymis protein 4 (HE4)[23] are potential serum markers for the diagnosis of UC. Heavy metals may be specific to endemic regions, the application of the nomogram may be limited to the endemic regions

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Conclusion