Prognostic evaluation of non-muscle invasive bladder cancer with P-CRP and its nomogram.

PURPOSE

To investigate the impact of the product of preoperative platelet count and C-reactive protein (P-CRP) on the postoperative prognosis of patients with non-muscle invasive bladder cancer (NMIBC), and to construct a Nomogram to predict the recurrence-free survival (RFS) of NMIBC patients based on pathological data.

METHODS

A retrospective analysis was conducted on the clinical data of 164 NMIBC patients who underwent transurethral resection of bladder tumors (TURBT) at the Second Affiliated Hospital of University of South China from January 2013 to December 2019. The endpoint of the study was the RFS. Kaplan-Meier (KM) method and Cox regression were used for analysis to identify independent factors affecting RFS. Then, the Nomogram was used to visualize the results of the multivariate analysis that were statistically significant and related to the RFS of NMIBC patients. Finally, the predictive ability of the model was evaluated using the concordance index (C-index) and calibration curves.

RESULTS

Before the end of the follow-up, the RFS was 88.3% at 1 year, 75.5% at 2 years, and 58.5% at 3 years. KM curves showed that P-CRP (HR=0.357, 95% CI: 0.204-0.625, P<0.001), number of tumors (HR=2.658, 95% CI: 1.572-4.494, P<0.001), tumor size (HR=2.271, 95% CI: 1.377-3.745, P=0.001), T stage of the tumor (HR=2.026, 95% CI: 1.233-3.329, P=0.005), and tumor G grade (G2: HR=1.615, 95% CI: 0.48-5.433, G3: HR=3.361, 95% CI: 1.022-11.054) were independent factors affecting the RFS of NMIBC patients after TURBT. The Nomogram could estimate the risk of tumor recurrence at 1, 2, and 3 years postoperatively. The Nomogram model incorporating P-CRP parameters had a higher predictive accuracy than the classic model that only included EORTC risk group parameters.

CONCLUSION

Preoperative P-CRP has a certain impact on the RFS of NMIBC patients after TURBT. The Nomogram incorporating P-CRP, number of tumors, tumor size, T stage, and tumor pathological grading can better predict the postoperative recurrence risk of NMIBC patients.