title: The clinical use of statistical permutation test methodology: a tool for identifying predictive variables of outcome.
abstract: OBJECTIVE
  To identify the predictive variables affecting the outcome after radical surgery for bladder cancer by a newer statistical methodology, i.e. nonparametric combination (NPC).
  
  
  METHODS
  A multicenter study enrolled 1,312 patients who had undergone radical cystectomy for bladder cancer in 11 Italian oncological centers from January 1982 to December 2002. A statistical analysis of their medical history and diagnostic, pathological and postoperative variables was performed using a NPC test. The patients were included in a comprehensive database with medical history and clinical and pathological data. Five-year survival was used as the dependent variable, and p values were corrected for multiplicity using a closed testing procedure. The newer nonparametric approach was used to evaluate the prognostic importance of the variables. All of the analyses were performed using routines developed in MATLAB© and the significance level was set at α = 0.05.
  
  
  RESULTS
  A significant prognostic predictive value (p < 0.01) for tumor clinical staging, hydronephrosis, tumor pathological staging, grading, presence of concomitant carcinoma in situ, regional lymph node involvement, corpora cavernosa invasion, microvascular invasion, lymphatic invasion and prostatic stroma involvement was found.
  
  
  CONCLUSIONS
  The NPC test could handle any type of variable (categorical and quantitative) and take into account the multivariate relation among variables. This newer methodology offers a significant contribution in biomedical studies with several endpoints and is recommended in presence of non-normal data and missing values, as well as solving high-dimensional data and problems relating to small sample sizes.
authors.affiliation: Department of Urology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Racioppi
authors.forename: L
authors.initials: L
authors.lastname: Salmaso
authors.forename: C
authors.initials: C
authors.lastname: Brombin
authors.forename: R
authors.initials: R
authors.lastname: Arboretti
authors.forename: D
authors.initials: D
authors.lastname: D'Agostino
authors.forename: R
authors.initials: R
authors.lastname: Colombo
authors.forename: V
authors.initials: V
authors.lastname: Serretta
authors.forename: M
authors.initials: M
authors.lastname: Brausi
authors.forename: G
authors.initials: G
authors.lastname: Casetta
authors.forename: P
authors.initials: P
authors.lastname: Gontero
authors.forename: R
authors.initials: R
authors.lastname: Hurle
authors.forename: R
authors.initials: R
authors.lastname: Tenaglia
authors.forename: V
authors.initials: V
authors.lastname: Altieri
authors.forename: R
authors.initials: R
authors.lastname: Bartoletti
authors.forename: M
authors.initials: M
authors.lastname: Maffezzini
authors.forename: S
authors.initials: S
authors.lastname: Siracusano
authors.forename: G
authors.initials: G
authors.lastname: Morgia
authors.forename: P F
authors.initials: PF
authors.lastname: Bassi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D007558:Italy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D012189:Retrospective Studies; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D001749:Urinary Bladder Neoplasms / Q000601:surgery