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Development of a nomogram to predict non-organ-confined bladder urothelial cancer before radical cystectomy

  • Urology - Original Paper
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Abstract

Purpose

To create a preoperative prediction model for estimating the risk of non-organ-confined (pT3-4 or pN+) bladder urothelial cancer (NOC–BUC) in patients with clinically OC–BUC (cT1-2N0M0).

Methods

The study involved 248 consecutive patients who had undergone radical surgery for clinically OC–BUC at a tertiary cancer center between 2003 and 2011. Logistic regression analysis was used to develop a prediction model for estimating the risk of pathological NOC disease. Prespecified predictors included age, gender, recurrent frequency, tumor size and number, hydronephrosis, and pathological characteristics at transurethral resection (T-stage, tumor grade, lymphovascular invasion (LVI), and carcinoma in situ). Discrimination ability was measured by the area under the receiver operating characteristic curve (AUC).

Results

Overall, 39.1 % of the patients with clinically OC–BUC had NOC disease at the time of radical surgery. In multivariate analysis, recurrent frequency, tumor size, hydronephrosis, and three pathological features at transurethral resection (T-stage, tumor grade, and LVI) were significantly associated with disease extent. The final prediction model included seven variables after backward elimination and achieved a bootstrap-corrected AUC of 0.79. Internal validation showed good calibration and clinical usefulness of the nomogram.

Conclusions

Based on readily available clinicopathological parameters, we developed a nomogram for predicting NOC tumor in clinically OC–BUC. Despite reasonable performance in internal validation, the prediction model should be assessed in external dataset before applied in clinical setting.

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Abbreviations

NOC–BUC:

Non-organ-confined bladder urothelial cancer

OC–BUC:

Organ-confined bladder urothelial cancer

LVI:

Lymphovascular invasion

AUC:

Area under curve

RC:

Radical cystectomy

PLND:

Pelvic lymph node dissection

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TUR:

Transurethral resection

CIS:

Carcinoma in situ

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong’an Road, Shanghai, 200032, People’s Republic of China

    Hu-Yang Xie, Yao Zhu, Xu-Dong Yao, Shi-Lin Zhang, Bo Dai, Hai-Liang Zhang, Yi-Jun Shen & Ding-Wei Ye

  2. Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China

    Chao-Fu Wang & Hui-Zhi Zhang

  3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Hu-Yang Xie, Yao Zhu, Xu-Dong Yao, Shi-Lin Zhang, Bo Dai, Hai-Liang Zhang, Yi-Jun Shen, Chao-Fu Wang, Hui-Zhi Zhang & Ding-Wei Ye

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  1. Hu-Yang Xie
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Correspondence to Ding-Wei Ye.

Additional information

Hu-Yang Xie and Yao Zhu contributed equally to this work.

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Xie, HY., Zhu, Y., Yao, XD. et al. Development of a nomogram to predict non-organ-confined bladder urothelial cancer before radical cystectomy. Int Urol Nephrol 44, 1711–1719 (2012). https://doi.org/10.1007/s11255-012-0273-2

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