Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Medical Statistics, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY.
Urol Oncol. 2023 Jun;41(6):296.e17-296.e28. doi: 10.1016/j.urolonc.2023.01.019. Epub 2023 Mar 15.
Sarcomatoid urothelial carcinoma (SUC) is a rare and aggressive variant of bladder cancer with limited data guiding prognosis. In this study, we present the first prognostic nomograms in the literature for 3- and 5-year overall survival (OS) and disease-specific survival (DSS), for patients with SUC derived from the surveillance, epidemiology and end results database (SEER).
Patients with SUC were identified by using the ICD-10 topography codes C67.0-C67.9 (bladder cancer), and the morphologic code 8122 (SUC). Patients were randomly divided into a training cohort (TC) and a validation cohort (VC) (7:3 ratio). Variables significantly associated with OS and DSS were identified with multivariate Cox regression and were used to build the nomograms. Harrel's C-statistic with bootstrap resampling and calibration curves were used for internal (TC) and external (VC) validation. Clinical utility of the nomograms was assessed with the decision curve analysis (DCA). Goodness of fit between the nomograms and the AJCC 8th edition staging system was compared with the likelihood ratio test.
A total of 741 patients with SUC were included (507 TC, 234 VC). No statistically significant differences in baseline characteristics were identified between the 2 cohorts. Sex, SEER stage, radical cystectomy and chemotherapy were common variables for the OS and the DSS nomograms with the addition of age in the former. Optimism-corrected C-statistic for the nomograms was 0.68 and 0.67 for OS and DSS respectively. In comparison, C-statistic for AJCC was 0.59 for OS and 0.60 for DSS (P < 0.001). Calibration curves constructed for the nomograms showed appropriate consistency between predicted and actual survival. The nomograms demonstrated optimal clinical utility in the DCA, outperforming the AJCC staging system, by maintaining a higher clinical net benefits than treat all, treat none and AJCC curves, across threshold probabilities.
We present the first prognostic nomograms developed in patients with SUC. Our models demonstrated superior prognostic performance to the AJCC system, by utilizing a set of variables readily available in daily practice and may serve as useful tools for the individualized risk assessment of these patients.
肉瘤样尿路上皮癌（SUC）是一种罕见且侵袭性的膀胱癌变体，其预后数据有限。在这项研究中，我们首次提出了基于监测、流行病学和最终结果数据库（SEER）的 SUC 患者 3 年和 5 年总生存（OS）和疾病特异性生存（DSS）的预后列线图。
通过使用 ICD-10 解剖学代码 C67.0-C67.9（膀胱癌）和形态学代码 8122（SUC），识别出患有 SUC 的患者。患者被随机分为训练队列（TC）和验证队列（VC）（比例为 7:3）。使用多变量 Cox 回归确定与 OS 和 DSS 显著相关的变量，并用于构建列线图。使用 Harrell 的 C 统计量和 bootstrap 重采样以及校准曲线对内（TC）和外（VC）进行验证。使用决策曲线分析（DCA）评估列线图的临床实用性。通过似然比检验比较列线图与 AJCC 第 8 版分期系统的拟合优度。
共纳入 741 例 SUC 患者（507 例 TC，234 例 VC）。两组患者的基线特征无统计学差异。性别、SEER 分期、根治性膀胱切除术和化疗是 OS 和 DSS 列线图的常见变量，前者还增加了年龄。列线图的校正后 C 统计量分别为 OS 和 DSS 的 0.68 和 0.67。相比之下，AJCC 的 C 统计量分别为 OS 的 0.59 和 DSS 的 0.60（P<0.001）。为列线图构建的校准曲线显示了预测和实际生存之间的适当一致性。在 DCA 中，列线图表现出最佳的临床实用性，优于 AJCC 分期系统，在整个阈值概率范围内保持了比治疗所有、治疗无和 AJCC 曲线更高的临床净效益。
我们提出了首个针对 SUC 患者的预后列线图。我们的模型通过利用一组在日常实践中易于获得的变量，表现出优于 AJCC 系统的预后性能，可作为这些患者个体化风险评估的有用工具。
