Precystectomy nomogram for prediction of advanced bladder cancer stage.
OBJECTIVE
To evaluate precystectomy prediction of pT and pN stages at cystectomy.


METHODS
Multivariate logistic regression analyses modelled variables of 726 evaluable patients treated with radical cystectomy and bilateral pelvic lymphadenectomy. The first set of models predicted pT(3-4) stage at cystectomy, and the second set predicted pN(1-3) stages at cystectomy. Transurethral resection (TUR) predictors consisted of 2002 T stage, 1973 WHO tumour grade, presence of carcinoma in situ, age, gender, and delivery of neo-adjuvant chemotherapy. The area under the ROC curve quantified nomogram accuracy. Two hundred bootstrap resamples were used to reduce overfit bias.


RESULTS
At TUR, 11% of patients were staged as pT(3-4) versus 42% at cystectomy. Lymph node metastases were found in 24% of patients at cystectomy (pN(1-3)). The multivariate pT(3-4) nomogram was 75.7% accurate versus 71.4% for TUR T stage. The multivariate pN(1-3) nomogram was 63.1% accurate versus 61.0% for TUR T stage.


CONCLUSIONS
Multivariate nomograms are not perfect, but they do predict more accurately than TUR T stage alone.
Karakiewicz
Pierre I
PI
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada. pierre.karakiewicz@umontreal.ca <pierre.karakiewicz@umontreal.ca>
Shariat
Shahrokh F
SF
Palapattu
Ganesh S
GS
Perrotte
Paul
P
Lotan
Yair
Y
Rogers
Craig G
CG
Amiel
Gilad E
GE
Vazina
Amnon
A
Gupta
Amit
A
Bastian
Patrick J
PJ
Sagalowsky
Arthur I
AI
Schoenberg
Mark
M
Lerner
Seth P
SP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D049451:Nomograms; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery