Chen Song, Lu Mengxin, Peng Tianchen, Wang Yejinpeng, Liu Xuefeng, Xiao Yu, Wang Xinghuan
Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
Human Genetics Resource Preservation Center of Wuhan University, Wuhan, 430071, China.
J Cancer. 2019 Oct 11;10(24):5891-5902. doi: 10.7150/jca.35866. eCollection 2019.
We aim to determine clinical recurrence and progression risk factors of T1G3 bladder cancer (BCa), and to establish recurrence and progression prediction models. 5-year follow-up records of 106 T1G3 BCa patients from January 2012 to December 2016 were analyzed for recurrence and progression. Two-sample T-test, Chi-square test, Mann-Whitney test, Kaplan-Meier curves, Cox univariate and multivariate analyses were performed to determine the independent risk factors. Effective prognostic nomograms were established to provide individualized prediction, and the calibration curves were founded to evaluate the agreements of the predicted probability with the actual observed probability. Receiver operating characteristic (ROC) curves were generated for the recurrence and progression prediction models. The stability of prediction models was validated with an external cohort included 61 T1G3 BCa patients. Of the 106 T1G3 BCa patients, 77 were males (72.6%) and 29 were females (27.4%), with median age 70 years. Within 5 years, recurrence was identified in 67 cases (63.2%), and progression was identified in 31 cases (29.2%). The results showed that large size of tumor, multifocal tumors, recrudescent tumor, non-BCG perfusion therapy were the independent risk factors for recurrence, and large size of tumor, multifocal tumors, recrudescent tumor, concomitant carcinoma in situ (CIS) were the independent risk factors for progression. However, no evidence shown that tumor location or operative method was independent risk factors for recurrence and progression. Based on the results of Cox regression analyses, the independent risk factors were used to establish the prediction nomograms to calculate the recurrence and progression probability of each T1G3 BCa patient. Calibration curves, ROC curves and external validation displayed that the nomograms had great value of prediction.
我们旨在确定T1G3期膀胱癌（BCa）的临床复发和进展危险因素，并建立复发和进展预测模型。分析了2012年1月至2016年12月期间106例T1G3期BCa患者的5年随访记录，以了解复发和进展情况。采用两样本T检验、卡方检验、曼-惠特尼检验、Kaplan-Meier曲线、Cox单因素和多因素分析来确定独立危险因素。建立有效的预后列线图以提供个体化预测，并绘制校准曲线以评估预测概率与实际观察概率的一致性。为复发和进展预测模型生成受试者操作特征（ROC）曲线。通过纳入61例T1G3期BCa患者的外部队列验证了预测模型的稳定性。106例T1G3期BCa患者中，男性77例（72.6%），女性29例（27.4%），中位年龄70岁。5年内，67例（63.2%）出现复发，31例（29.2%）出现进展。结果显示，肿瘤体积大、多灶性肿瘤、复发性肿瘤以及非卡介苗灌注治疗是复发的独立危险因素，肿瘤体积大、多灶性肿瘤、复发性肿瘤以及原位癌（CIS）并存是进展的独立危险因素。然而，没有证据表明肿瘤位置或手术方式是复发和进展的独立危险因素。基于Cox回归分析结果，使用独立危险因素建立预测列线图，以计算每位T1G3期BCa患者的复发和进展概率。校准曲线、ROC曲线和外部验证表明列线图具有很大的预测价值。
