Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt.
BJU Int. 2013 Jun;111(8):E331-41. doi: 10.1111/bju.12026. Epub 2013 Feb 27.
To construct predictive models based on the objectively calculated risks of progression and recurrence of non-muscle-invasive bladder cancer (NMIBC) in a large cohort of patients from a single centre.
Between October 1984 and March 2009 a cohort of 1019 patients (877 males; 142 females; median age 44 years) with histologically confirmed NMIBC was included in this study. Among these patients, 74% received bacillus Calmette-Guérin (BCG)-based therapy. Complete transurethral resection of bladder tumour of all visible tumours was carried out in all patients, and the stage and grade were determined. Univariate analysis and multivariate Cox regression were used to identify predictors of recurrence and progression. The studied predictors included age, sex, stage, grade, associated carcinoma in situ, tumour size, multiplicity, macroscopic appearance of the tumour, history of recurrence and type of adjuvant intravesical therapy. Multivariate logistic regression models were used to develop the 12- and 60-month recurrence and progression predictive models. The predictive accuracy of the models was assessed for discrimination as well as calibration.
The median (range) follow-up was 44 (6-254) months. On multivariate analysis, stage, multiplicity, history of recurrence and adjuvant intravesical therapy were significantly associated with recurrence, whereas for progression only tumour grade and size were significant independent predictors. The constructed nomograms had a 64.9% and 69.4% chance of correctly distinguishing between two patients, one destined to have a recurrence and one not at 12 and 60 months, respectively. The constructed nomograms had a 70.2% and 73.5% chance of correctly distinguishing between two patients, one destined to progress and one not at 12 and 60 months, respectively. All predictive models were well calibrated.
Based on multivariate analysis of the studied prognostic factors nomograms for predicting recurrence and progression in NMIBC were constructed. Most of the studied patients had received BCG-based therapy, making these models more closely applicable to contemporary practice than others. These predictive models have reasonable discriminative ability and are well calibrated, but require external validation before they can be applied to other populations.
基于单中心大样本患者的客观计算进展和复发风险，构建非肌层浸润性膀胱癌（NMIBC）的预测模型。
1984 年 10 月至 2009 年 3 月，纳入了本研究的 1019 例经组织学证实的 NMIBC 患者（男 877 例，女 142 例；中位年龄 44 岁）。其中 74%的患者接受了卡介苗（BCG）治疗。所有患者均进行了完整的经尿道膀胱肿瘤切除术，确定了肿瘤的分期和分级。采用单因素分析和多因素 Cox 回归分析识别复发和进展的预测因素。研究的预测因素包括年龄、性别、分期、分级、原位癌、肿瘤大小、多发性、肿瘤的大体外观、复发史和辅助膀胱内治疗类型。采用多因素逻辑回归模型建立 12 个月和 60 个月的复发和进展预测模型。评估模型的区分度和校准度来评估预测准确性。
中位（范围）随访时间为 44（6-254）个月。多因素分析显示，分期、多发性、复发史和辅助膀胱内治疗与复发显著相关，而对于进展，只有肿瘤分级和大小是独立的显著预测因素。构建的列线图在 12 个月和 60 个月时，分别有 64.9%和 69.4%的机会正确区分两个患者，一个注定复发，另一个不复发。构建的列线图在 12 个月和 60 个月时，分别有 70.2%和 73.5%的机会正确区分两个患者，一个注定进展，另一个不进展。所有预测模型的校准度都很好。
基于对研究预后因素的多因素分析，构建了预测 NMIBC 复发和进展的列线图。大多数研究患者接受了 BCG 治疗，这使得这些模型比其他模型更能适应当代实践。这些预测模型具有合理的区分能力和良好的校准度，但在应用于其他人群之前需要进行外部验证。
