Xia Yu, Liu Xi, Ma Binbin, Huang Tao, Xu Danfeng, Zhao Chenhui
Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine Shanghai, China.
Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China.
Am J Clin Exp Urol. 2023 Dec 15;11(6):500-515. eCollection 2023.
Recent developments in bladder cancer treatment strategies have significantly improved the prognosis of clinically curable muscle invasive bladder cancer (MIBC) patients. Here, the prognostic factors of T2-4a, N0-x, M0 MIBC patients were investigated using the Surveillance, Epidemiology, and End Results (SEER) database and a novel nomogram model was established for prognosis prediction.
The data of 7,292 patients with T2-4a, N0-x, M0 MIBC were retrieved from the SEER database (2000-2020) and randomly classified into a training set (n = 5,106) and validation set (n = 2,188). Kaplan-Meier analysis was used to calculate cancer-specific survival (CSS) and overall survival (OS) rates of patients, and differences between survival curves were analyzed using the log-rank test. Cox regression analysis was used to screen and incorporate patient prognosis-affecting independent risk factors into the nomogram model. Consistency index (C-index) values and areas under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate the discriminatory ability, and the calibration curve was used to assess the calibration of the model. Its predictive performance and American Joint Committee on Cancer (AJCC) stage were compared using decision curve analysis (DCA).
The 1-, 3-, and 5-year CSS and OS rates of patients with T2-4a, N0-x, M0 MIBC were 76.9%, 56.0%, and 49.9%, respectively, and 71.3%, 47.9%, and 39.5%, respectively. Cox regression analysis showed that age, marital status, race, pathological type, tumor size, AJCC stage, T stage, N stage, surgery of primary tumor, regional lymph node dissection, radiation, and chemotherapy were independent prognostic risk factors of both CSS and OS (P < 0.05). The C-index and AUC of the nomogram model constructed based on the training and validation sets were both > 0.7, and calibration curves for predicting the 1-, 3-, and 5-year survival were consistent with the ideal curve. The nomogram model showed a higher net benefit with DCA than AJCC stage analysis.
The nomogram model could accurately predict the prognosis of patients with T2-4a, N0-x, M0 MIBC. It may help clinicians perform personalized prognosis evaluations and formulate treatment plans.
膀胱癌治疗策略的最新进展显著改善了临床可治愈的肌层浸润性膀胱癌（MIBC）患者的预后。在此，利用监测、流行病学和最终结果（SEER）数据库研究了T2-4a、N0-x、M0 MIBC患者的预后因素，并建立了一种新型列线图模型用于预后预测。
从SEER数据库（2000 - 2020年）中检索7292例T2-4a、N0-x、M0 MIBC患者的数据，并随机分为训练集（n = 5106）和验证集（n = 2188）。采用Kaplan-Meier分析计算患者的癌症特异性生存（CSS）率和总生存（OS）率，并使用对数秩检验分析生存曲线之间的差异。采用Cox回归分析筛选并将影响患者预后的独立危险因素纳入列线图模型。一致性指数（C-index）值和时间依赖性受试者工作特征曲线下面积（AUC）用于评估鉴别能力，校准曲线用于评估模型的校准情况。使用决策曲线分析（DCA）比较其预测性能与美国癌症联合委员会（AJCC）分期。
T2-4a、N0-x、M0 MIBC患者的1年、3年和5年CSS率分别为76.9%、56.0%和49.9%，OS率分别为71.3%、47.9%和39.5%。Cox回归分析显示，年龄、婚姻状况、种族、病理类型、肿瘤大小、AJCC分期、T分期、N分期、原发肿瘤手术、区域淋巴结清扫、放疗和化疗是CSS和OS的独立预后危险因素（P < 0.05）。基于训练集和验证集构建的列线图模型的C-index和AUC均> 0.7，预测1年、3年和5年生存的校准曲线与理想曲线一致。列线图模型在DCA中显示出比AJCC分期分析更高的净效益。
列线图模型可准确预测T2-4a、N0-x、M0 MIBC患者的预后。它可能有助于临床医生进行个性化预后评估并制定治疗方案。
