Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany.
BJU Int. 2010 Aug;106(3):342-8. doi: 10.1111/j.1464-410X.2009.09138.x. Epub 2009 Dec 11.
To determine whether published nomograms, i.e. The International Bladder Cancer Nomogram Consortium (IBCNC) and the Bladder Cancer Research Consortium (BCRC) statistical models for predicting disease recurrence and survival of patients after radical cystectomy, are feasible for routine use in intermediate-volume institutions in Europe, as although these nomograms had high accuracy by internal validation tests, they stem from high-volume centres and have not been validated elsewhere and thus their general applicability remains unproven.
We externally validated the published nomograms. Information about treatments, pathological details, and recurrence and survival status was retrospectively collected from 246 patients. The expected survival according to the nomograms was calculated. The predictive accuracy of the proposed models was calculated by Harrell's concordance indices. To assess the independent prognostic value of the variables proposed by IBCNC and BCRC, stepwise multivariable Cox regressions based on Akaike's Information Criterion (AIC) for the different endpoints were used. A best model for prediction was created on the basis of our data.
The IBCNC and the BCRC nomograms showed an improvement in the predictive accuracy of recurrence, all-cause and bladder-cancer-specific survival after radical cystectomy of up to 4% compared to Tumour-Node-Metastasis stage-based predictions. According to the calculated AIC values for the different models, all nomograms performed better than the TNM classification.
The BCRC and IBCNC nomograms provided accurate predictions when they were applied to an external cohort of patients from low- to intermediate-volume centres. The prediction of recurrence and survival based on the addressed nomograms is better than TNM stage-based prediction. The application of such nomograms can be supported on a sound basis, but further amendments are warranted.
确定发表的列线图（即国际膀胱癌列线图联盟（IBCNC）和膀胱癌研究联盟（BCRC）的统计模型）是否可用于预测根治性膀胱切除术后患者的疾病复发和生存，对于欧洲中等容量机构的常规使用是否可行，因为尽管这些列线图通过内部验证测试具有较高的准确性，但它们源于大容量中心，尚未在其他地方进行验证，因此其普遍适用性仍未得到证实。
我们对发表的列线图进行了外部验证。从 246 名患者中回顾性收集了关于治疗、病理细节、复发和生存状况的信息。根据列线图计算预期的生存情况。通过 Harrell 的一致性指数（concordance index）计算提出模型的预测准确性。为了评估 IBCNC 和 BCRC 提出的变量的独立预后价值，我们基于 Akaike 的信息准则（AIC）使用逐步多变量 Cox 回归对不同终点进行了分析。根据我们的数据，创建了一个最佳预测模型。
与基于肿瘤-淋巴结-转移（TNM）分期的预测相比，IBCNC 和 BCRC 列线图在预测根治性膀胱切除术后的复发、全因和膀胱癌特异性生存方面的预测准确性提高了 4%。根据不同模型的计算 AIC 值，所有列线图的表现均优于 TNM 分类。
BCRC 和 IBCNC 列线图在应用于来自低至中等容量中心的外部患者队列时提供了准确的预测。基于所提出的列线图进行的复发和生存预测优于基于 TNM 分期的预测。可以在可靠的基础上支持此类列线图的应用，但需要进一步修订。
