title: Prediction of Locally Advanced Urothelial Carcinoma of the Bladder Using Clinical Parameters before Radical Cystectomy--A Prospective Multicenter Study.
abstract: BACKGROUND
  We aimed at developing and validating a pre-cystectomy nomogram for the prediction of locally advanced urothelial carcinoma of the bladder (UCB) using clinicopathological parameters.
  
  
  METHODS
  Multicenter data from 337 patients who underwent radical cystectomy (RC) for UCB were prospectively collected and eligible for final analysis. Univariate and multivariate logistic regression models were applied to identify significant predictors of locally advanced tumor stage (pT3/4 and/or pN+) at RC. Internal validation was performed by bootstrapping. The decision curve analysis (DCA) was done to evaluate the clinical value.
  
  
  RESULTS
  The distribution of tumor stages pT3/4, pN+ and pT3/4 and/or pN+ at RC was 44.2, 27.6 and 50.4%, respectively. Age (odds ratio (OR) 0.980; p < 0.001), advanced clinical tumor stage (cT3 vs. cTa, cTis, cT1; OR 3.367; p < 0.001), presence of hydronephrosis (OR 1.844; p = 0.043) and advanced tumor stage T3 and/or N+ at CT imaging (OR 4.378; p < 0.001) were independent predictors for pT3/4 and/or pN+ tumor stage. The predictive accuracy of our nomogram for pT3/4 and/or pN+ at RC was 77.5%. DCA for predicting pT3/4 and/or pN+ at RC showed a clinical net benefit across all probability thresholds.
  
  
  CONCLUSIONS
  We developed a nomogram for the prediction of locally advanced tumor stage pT3/4 and/or pN+ before RC using established clinicopathological parameters.
authors.affiliation: Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Lutz
authors.initials: L
authors.lastname: Trojan
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.forename: Stefan
authors.initials: S
authors.lastname: Zastrow
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
authors.forename: Johannes
authors.initials: J
authors.lastname: Moersdorf
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.forename: Florian
authors.initials: F
authors.lastname: Wagenlehner
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.forename: Lukas
authors.initials: L
authors.lastname: Lusuardi
authors.forename: Marc-Oliver
authors.initials: MO
authors.lastname: Grimm
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Müller
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
mesh_terms: D000368:Aged; D000465:Algorithms; D015653:Cystectomy / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods; D049451:Nomograms; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology* / Q000601:surgery*