title: Development of a nomogram to predict non-organ-confined bladder urothelial cancer before radical cystectomy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Shanghai, 200032, People's Republic of China.
authors.forename: Hu-Yang
authors.initials: HY
authors.lastname: Xie
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhu
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Yao
authors.forename: Shi-Lin
authors.initials: SL
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Dai
authors.forename: Hai-Liang
authors.initials: HL
authors.lastname: Zhang
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Shen
authors.forename: Chao-Fu
authors.initials: CF
authors.lastname: Wang
authors.forename: Hui-Zhi
authors.initials: HZ
authors.lastname: Zhang
authors.forename: Ding-Wei
authors.initials: DW
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D057234:Preoperative Period; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery