Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Urology, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Cancer Med. 2023 Dec;12(24):21627-21638. doi: 10.1002/cam4.6712. Epub 2023 Nov 16.
To investigate the prognostic significance of body composition and nutritional indicators in patients undergoing radical cystectomy with muscle-invasive bladder cancer (MIBC) and to develop a novel nomogram that accurately predicts overall survival (OS).
From December 2010 to December 2020, we retrospectively collected clinical and pathological data from 373 MIBC patients who underwent radical cystectomy at our hospital. Preoperative computed tomography (CT) images were used to measure the skeletal muscle index (SMI), subcutaneous adipose index (SAI), visceral adipose index (VAI), skeletal muscle density (SMD), subcutaneous adipose density (SAD), visceral adipose density (VAD), and visceral adipose to subcutaneous adipose area ratio (VSR). The clinicopathological characteristics were evaluated using LASSO regression and multivariate Cox regression, and a nomogram was constructed to predict 1-, 3-, and 5-year overall survival. The concordance index (C-index), time-dependent receiver operating characteristic curves (t-ROC), calibration curve, and decision curve analysis (DCA) were used to assess the discriminative ability, calibration, and clinical practicality of the nomogram.
Multivariate analyses demonstrated that pT stage, lymph node status, LVI, SMD, and prognostic nutritional index (PNI) are independent prognostic factors for OS. Additionally, a nomogram was created. The nomogram's C-index was 0.714 (95% CI: 0.695-0.733). The area under the t-ROC curve of 1-, 3-, and 5-year survival corresponding to the model was 0.726, 0.788, and 0.785, respectively. The calibration curve demonstrated excellent agreement between the predicted and observed outcomes. The DCA revealed that patients with MIBC could benefit from the nomogram.
Based on body composition and nutritional indicators, we developed a novel nomogram with excellent predictive accuracy and reliability for predicting the prognosis of MIBC patients undergoing RC.
研究肌层浸润性膀胱癌（MIBC）患者根治性膀胱切除术后的体成分和营养指标的预后意义，并建立一种新的列线图，以准确预测总生存期（OS）。
我们回顾性地收集了 2010 年 12 月至 2020 年 12 月期间在我院接受根治性膀胱切除术的 373 例 MIBC 患者的临床和病理数据。使用术前计算机断层扫描（CT）图像来测量骨骼肌指数（SMI）、皮下脂肪指数（SAI）、内脏脂肪指数（VAI）、骨骼肌密度（SMD）、皮下脂肪密度（SAD）、内脏脂肪密度（VAD）和内脏脂肪与皮下脂肪面积比（VSR）。使用 LASSO 回归和多变量 Cox 回归评估临床病理特征，并构建预测 1、3 和 5 年总生存率的列线图。一致性指数（C-index）、时间依赖性接受者操作特征曲线（t-ROC）、校准曲线和决策曲线分析（DCA）用于评估列线图的判别能力、校准和临床实用性。
多变量分析表明，pT 分期、淋巴结状态、LVI、SMD 和预后营养指数（PNI）是 OS 的独立预后因素。此外，还创建了一个列线图。该列线图的 C-index 为 0.714（95%CI：0.695-0.733）。模型对应于 1 年、3 年和 5 年生存率的 t-ROC 曲线下面积分别为 0.726、0.788 和 0.785。校准曲线显示预测结果与观察结果具有极好的一致性。DCA 显示 MIBC 患者可以从列线图中获益。
基于体成分和营养指标，我们开发了一种新的列线图，具有出色的预测准确性和可靠性，可用于预测接受 RC 的 MIBC 患者的预后。
