Nomograms including nuclear matrix protein 22 for prediction of disease recurrence and progression in patients with Ta, T1 or CIS transitional cell carcinoma of the bladder.
OBJECTIVE
We developed and validated nomograms that accurately predict disease recurrence and progression in patients with Ta, T1, or CIS transitional cell carcinoma (TCC) of the bladder using a large international cohort.


METHODS
Univariate and multivariate logistic regression models targeted histologically confirmed disease recurrence, and focused on 2,542 patients with bladder TCC from 10 participating centers. Variables consisted of pre-cystoscopy voided urine Nuclear Matrix Protein 22 (NMP22) assay, urine cytology, age and gender. Resulting nomograms were internally validated with bootstrapping. Nomogram performance was explored graphically with Loess smoothing plots.


RESULTS
Overall 957 patients had recurrent TCC. Tumor grade and stage was available for 898 patients, including 24% grade I, 43% grade II, and 33% grade III; 45% stage Ta, 32% T1 and/or CIS, and 23% T2 or greater. Bootstrap corrected predictive accuracy for any TCC recurrence was 0.842; grade III Ta/T1 or CIS was 0.869; and T2 or higher stage TCC of any grade was 0.858. Virtually perfect performance characteristics were observed for the nomograms predicting any TCC recurrence or grade III Ta/T1 or CIS. The nomogram predicting T2 or higher stage TCC overestimated the observed probability for predicted values greater than 45%.


CONCLUSIONS
We developed and internally validated nomograms that incorporate urinary NMP22, cytology, age and gender to predict with high accuracy the probability of disease recurrence and progression in patients with Ta, T1, and/or CIS bladder TCC. These nomograms could provide a means for individualizing followup in patients with Ta, T1, CIS bladder TCC.
Shariat
Shahrokh F
SF
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA. Shahrokh.Shariat@UTSouthwestern.edu
Zippe
Craig
C
Lüdecke
Gerson
G
Boman
Hans
H
Sanchez-Carbayo
Marta
M
Casella
Roberto
R
Mian
Christine
C
Friedrich
Martin G
MG
Eissa
Sanaa
S
Akaza
Hideyuki
H
Sawczuk
Ihor
I
Serretta
Vincenzo
V
Huland
Hartwig
H
Hedelin
Hans
H
Rupesh
Raina
R
Miyanaga
Naoto
N
Sagalowsky
Arthur I
AI
Wians
Frank
F
Roehrborn
Claus G
CG
Lotan
Yair
Y
Perrotte
Paul
P
Benayoun
Serge
S
Marberger
Michael J
MJ
Karakiewicz
Pierre I
PI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000652:urine*; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000652:urine*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D049451:Nomograms; D009687:Nuclear Proteins / Q000652:urine*; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000652:urine*
D014408:Biomarkers, Tumor; D009687:Nuclear Proteins; C100379:nuclear matrix protein 22