title: Neurofuzzy modeling to determine recurrence risk following radical cystectomy for nonmetastatic urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  Bladder cancer recurrence occurs in 40% of patients following radical cystectomy (RC) and pelvic lymphadenectomy (PLND). Although recurrence can be reduced with adjuvant chemotherapy, the toxicity and low response rates of this treatment restrict its use to patients at highest risk. We developed a neurofuzzy model (NFM) to predict disease recurrence following RC and PLND in patients who are not usually administered adjuvant chemotherapy.
  
  
  METHODS
  The study comprised 1,034 patients treated with RC and PLND for bladder urothelial carcinoma. Four hundred twenty-five patients were excluded due to lymph node metastases and/or administration of chemotherapy. For the remaining 609 patients, we obtained complete clinicopathologic data relating to their tumor. We trained, tested, and validated two NFMs that predicted risk (Classifier) and timing (Predictor) of post-RC recurrence. We measured the accuracy of our model at various postoperative time points.
  
  
  RESULTS
  Cancer recurrence occurred in 172 (28%) patients. With a median follow-up of 72.7 months, our Classifier NFM identified recurrence with an accuracy of 0.84 (concordance index 0.92, sensitivity 0.81, and specificity 0.85) and an excellent calibration. This was better than two predictive nomograms (0.72 and 0.74 accuracies). The Predictor NFMs identified the timing of tumor recurrence with a median error of 8.15 months.
  
  
  CONCLUSIONS
  We have developed an accurate and well-calibrated model to identify disease recurrence following RC and PLND in patients with nonmetastatic bladder urothelial carcinoma. It seems superior to other available predictive methods and could be used to identify patients who would potentially benefit from adjuvant chemotherapy.
authors.affiliation: Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK. J.Catto@sheffield.ac.uk
authors.forename: James W F
authors.initials: JW
authors.lastname: Catto
authors.forename: Maysam F
authors.initials: MF
authors.lastname: Abbod
authors.forename: Derek A
authors.initials: DA
authors.lastname: Linkens
authors.forename: Stéphane
authors.initials: S
authors.lastname: Larré
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rosario
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy