Chen Tao, Zhan Xiangpeng, Chen Xinpeng, Jiang Ming, Wan Hao, Fu Bin, Chen Luyao
Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang City, China.
The First Clinical Medical College of Nanchang University, Nanchang City, China.
Front Oncol. 2022 Jul 19;12:895413. doi: 10.3389/fonc.2022.895413. eCollection 2022.
The effect of lymph node resection on the prognosis of bladder cancer (BLCA) patients receiving radical cystectomy should not be ignored. Our aim was to explore the prognostic value of the log odds of negative lymph nodes/T stage (LONT) and construct a more effective nomogram based on LONT to predict cancer-specific survival (CSS) in postoperative BLCA patients.
Patients diagnosed with BLCA after radical cystectomy between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled. We randomly split (7:3) these patients into the primary cohort and internal validation cohort. 86 patients from the First Affiliated Hospital of Nanchang University were collected as the external validation set. Univariate and multivariate cox regression analyses were carried out to seek prognostic factors of postoperative BLCA patients. According to these significantly prognostic factors, a simple-to-use nomogram was established for predicting CSS. Their performances were evaluated by using calibration curves, the concordance index (C-index), the receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). In addition, different risk groups were tested by Kaplan-Meier curves and log-rank tests.
Whether in cancer-specific survival (CSS) or overall survival (OS), LONT was an independent and significant prognostic factor. Through further screening, the ultimate nomogram of CSS was composed of nine independent prognostic factors including LONT, age, race, tumor size, histologic type, T stage, N stage, summary stage and chemotherapy. The C-index of nomogram in the primary cohort, internal and external validation cohort were 0.734, 0.720 and 0.728, respectively. The AUC of predicting CSS at 3 and 5 years were 0.783 and 0.774 in the primary cohort and 0.781 and 0.781 in the validation cohort. The results of calibration and DCA showed good concordance and clinical applicability. Significant differences (P < 0.05) were displayed in CSS among different risk groups.
LONT was regarded as a novel and reliable prognostic factor. Compared with the AJCC staging system, the established nomogram based on LONT can more effectively predict the prognosis of BLCA patients after radical cystectomy.
淋巴结切除对接受根治性膀胱切除术的膀胱癌（BLCA）患者预后的影响不容忽视。我们的目的是探讨阴性淋巴结/ T分期对数优势（LONT）的预后价值，并基于LONT构建更有效的列线图，以预测术后BLCA患者的癌症特异性生存（CSS）。
纳入2004年至2015年期间在监测、流行病学和最终结果（SEER）数据库中诊断为根治性膀胱切除术后BLCA的患者。我们将这些患者随机（7:3）分为初级队列和内部验证队列。收集南昌大学第一附属医院的86例患者作为外部验证集。进行单因素和多因素cox回归分析，以寻找术后BLCA患者的预后因素。根据这些显著的预后因素，建立了一个简单易用的列线图来预测CSS。通过校准曲线、一致性指数（C指数）、受试者操作特征（ROC）曲线和决策曲线分析（DCA）对其性能进行评估。此外，通过Kaplan-Meier曲线和对数秩检验对不同风险组进行测试。
无论是癌症特异性生存（CSS）还是总生存（OS），LONT都是一个独立且显著的预后因素。通过进一步筛选，CSS的最终列线图由九个独立的预后因素组成，包括LONT、年龄、种族、肿瘤大小、组织学类型、T分期、N分期、总结分期和化疗。初级队列、内部和外部验证队列中列线图的C指数分别为0.734、0.720和0.728。初级队列中预测CSS在3年和5年时的AUC分别为0.783和0.774，验证队列中分别为0.781和0.781。校准和DCA的结果显示出良好的一致性和临床适用性。不同风险组之间的CSS显示出显著差异（P < 0.05）。
LONT被视为一种新的可靠预后因素。与美国癌症联合委员会（AJCC）分期系统相比，基于LONT建立的列线图可以更有效地预测根治性膀胱切除术后BLCA患者的预后。
