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External Validation of Online Predictive Models for Prediction of Cancer-specific Mortality and All-cause Mortality in Patients with Urothelial Carcinoma of the Urinary Bladder

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The objective of the study was to validate the previously reported lookup Table and Bladder Cancer Research Consortium (BCRC) nomogram in predicting cancer-specific mortality (CSM) and all-cause mortality (ACM) after radical cystectomy using an external cohort from South Korea.

Methods

The study comprised 409 patients. Discrimination was quantified with the concordance index. The relationship between the model-derived and actual CSM and ACM was graphically explored within calibration plots. Clinical net benefit was evaluated by decision curve analysis.

Results

Of the 409 patients, 147 (35.9 %) had died from various causes. One hundred two deaths were attributable to bladder cancer. For CSM at 5 years, the bootstrap-corrected concordance indices of the American Joint Committee on Cancer (AJCC) staging system, lookup Table, and BCRC nomogram were 71.8 % (95 % confidence interval [CI] 66.9–76.5), 73.0 % (95 % CI 67.9–78.0), and 76.2 % (95 % CI 71.6–80.9), respectively. For ACM at the same time point, the discrimination accuracies of these models were 70.7 % (95 % CI 66.7–74.6), 72.8 % (95 % CI 68.5–76.9), and 76.2 % (95 % CI 72.3–80.2), respectively. The calibration plots tended to exaggerate both survival outcomes in all models. When compared to the lookup Table as well as the AJCC staging system, the BCRC nomogram performed well across a wide range of threshold probabilities using decision curve analysis.

Conclusions

The BCRC nomogram was characterized by higher accuracy and larger potential clinical benefit compared to the lookup Table. However, there is a great need for additional models that consider outcomes of patients for whom the existing models do not apply.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    Kyung Chul Moon MD, PhD

  2. Department of Urology, Seoul National University College of Medicine, Seoul, Korea

    Myong Kim MD, Cheol Kwak MD, PhD, Hyeon Hoe Kim MD, PhD & Ja Hyeon Ku MD, PhD

Authors
  1. Kyung Chul Moon MD, PhD
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  2. Myong Kim MD
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  3. Cheol Kwak MD, PhD
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  4. Hyeon Hoe Kim MD, PhD
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  5. Ja Hyeon Ku MD, PhD
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Corresponding author

Correspondence to Ja Hyeon Ku MD, PhD.

Appendix

Appendix

See Table 3 and Fig. 4.

Table 3 Nomograms for predicting outcome in patients treated with radical cystectomy for bladder cancer
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Fig. 4
figure 4

Distribution of model predictions with each AJCC staging system. a The look-up table predicted probability of 5-year cancer-specific mortality. b Bladder Cancer Research Consortium nomogram predicted probability of 5-year cancer-specific mortality. c The look-up table predicted probability of 5-year all-cause mortality. d Bladder Cancer Research Consortium nomogram predicted probability of 5-year all-cause mortality

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Moon, K.C., Kim, M., Kwak, C. et al. External Validation of Online Predictive Models for Prediction of Cancer-specific Mortality and All-cause Mortality in Patients with Urothelial Carcinoma of the Urinary Bladder. Ann Surg Oncol 21, 3132–3141 (2014). https://doi.org/10.1245/s10434-014-3561-5

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  • DOI: https://doi.org/10.1245/s10434-014-3561-5

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