External Validation of Bladder Cancer Predictive Nomograms for Recurrence, Cancer-Free Survival and Overall Survival following Radical Cystectomy.
OBJECTIVE
We externally validated 3 previously published nomograms to predicting recurrence, and cancer specific and overall survival following radical cystectomy and pelvic lymph node dissection for urothelial carcinoma of the bladder.


METHODS
Two surgeons from a single institution performed a total of 197 consecutive radical cystectomies and pelvic lymph node dissections for bladder cancer from January 2003 to September 2009. A total of 23 patients were excluded from analysis. Examined parameters were those used in the original nomograms, including patient age, gender, pathological T stage, N stage, tumor grade, presence of carcinoma in situ and lymphovascular invasion, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiation therapy. Nomogram predictions were compared to actuarial outcomes and predictive accuracy was quantified using measures of discrimination and calibration.


RESULTS
At the time of analysis 34 patients had experienced recurrence, of whom 28 died of disease and 6 were currently alive with disease. Discrimination at 2, 5 and 8 years was 0.776, 0.809 and 0.794 for recurrence, 0.822, 0.840 and 0.849 for cancer specific survival, and 0.812, 0.820 and 0.825, respectively, for overall survival. Calibration plots revealed nomogram overestimation of all 3 end points.


CONCLUSIONS
Nomograms for bladder cancer recurrence, cancer specific survival and overall survival following radical cystectomy and pelvic lymph node dissection performed well in our series with accuracy comparable to that in the original series. The use of nomogram predictions should be further explored in clinical trials to assess the impact on patient care in clinical practice.
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
Michael
M
Brooks
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
Guilherme
G
Godoy
University of Montreal Health Center, Montreal, Québec, Canada; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts.
Maxine
M
Sun
Bladder Cancer Research Consortium; Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; Weil Medical College Cornell University, New York, New York.
Shahrokh F
SF
Shariat
Bladder Cancer Research Consortium; Department of Urology, Rambam Health Care Campus, Haifa, Israel.
Gilad E
GE
Amiel
Scott Department of Urology, Baylor College of Medicine, Houston, Texas; Bladder Cancer Research Consortium. Electronic address: slerner@bcm.edu.
Seth P
SP
Lerner
D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D049451:Nomograms; D011237:Predictive Value of Tests; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
cystectomy; mortality; nomograms; urinary bladder neoplasms; validation studies