Liu Zhengli, Zhang Haojie, Luo Rongtuan, Wang Bin, Li Tengfei, Zheng Baoshou
Department of Urinary Surgery, The First Affiliated Hospital of Dali University, Dali, China.
Department of Urinary Surgery, Zhumadian Central Hospital, Zhumadian, China.
Transl Cancer Res. 2025 Feb 28;14(2):1111-1123. doi: 10.21037/tcr-24-1530. Epub 2025 Feb 26.
Bladder cancer is one of the most prevalent malignancies within the urinary system, with incidence and mortality rates showing a global upward trend. This study aims to examine the clinical characteristics of bladder cancer patients with a history of prior malignancies and to develop a prognostic model using extensive data from the Surveillance, Epidemiology, and End Results (SEER) database to inform clinical treatment strategies.
Data from bladder cancer patients diagnosed between 2011 and 2015 were extracted using SEER*Stat software. Statistical analyses, including Kaplan-Meier survival curves, and Cox regression, were conducted using R software version 3.6.1 to develop a nomogram model. The predictive performance of the nomogram was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and the concordance index (C-index).
A total of 12,260 bladder cancer patients were analyzed, including 8,959 individuals with no prior tumor history and 3,301 individuals with a history of previous tumors. The mean survival duration for patients with a prior tumor history was 56.04±39.96 months, significantly lower than the 70.28±39.36 months for patients without a prior tumor history (P<0.001). Significant differences were observed between the two groups across various clinical characteristics, such as age, race, gender, marital status, tumor location, tumor stage, and tumor grade. Multifactorial analysis identified age, race, gender, marital status, tumor grade, tumor stage, tumor histological type, surgical intervention, radiotherapy, chemotherapy, and prior tumor history as independent prognostic factors influencing survival. A nomogram was subsequently developed to predict overall mortality risk and 3- and 5-year survival rates, demonstrating robust predictive performance with a C-index and AUC exceeding 0.70.
Patients with a history of tumors exhibited lower survival rates and distinct clinical characteristics. The developed nomogram accurately predicts overall mortality and 3- and 5-year survival rates, offering potential for personalized prognostic assessments in clinical practice. Future research should validate the model's generalizability and include additional biological factors to enhance its predictive power.
膀胱癌是泌尿系统中最常见的恶性肿瘤之一，其发病率和死亡率呈全球上升趋势。本研究旨在探讨有既往恶性肿瘤病史的膀胱癌患者的临床特征，并利用监测、流行病学和最终结果（SEER）数据库的大量数据建立一个预后模型，为临床治疗策略提供参考。
使用SEER*Stat软件提取2011年至2015年期间诊断的膀胱癌患者的数据。使用R软件3.6.1版进行统计分析，包括Kaplan-Meier生存曲线和Cox回归，以建立列线图模型。使用受试者操作特征（ROC）曲线下面积（AUC）和一致性指数（C-index）评估列线图的预测性能。
共分析了12260例膀胱癌患者，其中8959例无既往肿瘤病史，3301例有既往肿瘤病史。有既往肿瘤病史患者的平均生存时间为56.04±39.96个月，显著低于无既往肿瘤病史患者的70.28±39.36个月（P<0.001）。两组在年龄、种族、性别、婚姻状况、肿瘤位置、肿瘤分期和肿瘤分级等各种临床特征方面存在显著差异。多因素分析确定年龄、种族、性别、婚姻状况、肿瘤分级、肿瘤分期、肿瘤组织学类型、手术干预、放疗、化疗和既往肿瘤病史是影响生存的独立预后因素。随后建立了一个列线图来预测总体死亡风险以及3年和5年生存率，其C-index和AUC超过0.70，显示出强大的预测性能。
有肿瘤病史的患者生存率较低且具有独特的临床特征。所建立的列线图能够准确预测总体死亡率以及3年和5年生存率，为临床实践中的个性化预后评估提供了可能。未来的研究应验证该模型的可推广性，并纳入更多生物学因素以增强其预测能力。
