The Upper TRACT Endometry Score: development and internal validation of an objective measure of variables that impact endoscopic procedures for upper tract urothelial carcinoma

Purpose: Endoscopic management (EM) is an increasingly accepted option for upper tract urothelial carcinoma (UTUC). Feasibility can be dependent on a variety of variables. The objective of this study was to identify anatomic and phenotypic tumor characteristics that impact EM, using structured expert forecasting, develop and obtain consensus on an assessment score, and perform initial validation of the score in a retrospective database.

Materials and methods: We used a modified Delphi method to elicit expert opinions, develop a scale, and gain consensus. Two survey rounds identified 5 consensus categories from which the Upper TRACT Endometry Score was created. An institutional UTUC database was used for initial validation. Patients with low-grade or high-grade UTUC undergoing EM were included. The Upper TRACT Endometry Score was calculated based on variables present at initial ureteroscopy. The primary outcome was extent of procedures received defined as a categorical, ordinal scale. The association of the Upper TRACT Endometry Score with outcomes was evaluated using multivariable ordinal logistic regression and Exact tests.

Results: Thirty international endourologic and urologic oncology experts participated in the surveys. One hundred ten renal units (102 patients) were identified for validation. Multivariable ordinal logistic regression demonstrated that as the Upper TRACT Endometry Score increases, the likelihood of requiring a more intensive intervention increases. Fischer's exact test suggested a significant relationship between the Upper TRACT Endometry Score and procedures received (p=0.004).

Conclusion: The Upper TRACT Endometry Score is a straightforward tool that with additional validation could be used to help counsel patients and to standardize reporting of variables that may impact endoscopic management of UTUC.