Precystectomy nomogram for prediction of advanced bladder cancer stage

• Published in: European urology 2006-12, Vol.50 (6), p.1254-1262
• Main Authors: Karakiewicz, Pierre I, Shariat, Shahrokh F, Palapattu, Ganesh S, Perrotte, Paul, Lotan, Yair, Rogers, Craig G, Amiel, Gilad E, Vazina, Amnon, Gupta, Amit, Bastian, Patrick J, Sagalowsky, Arthur I, Schoenberg, Mark, Lerner, Seth P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cystectomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging - methods; Nomograms; Predictive Value of Tests; Preoperative Care - methods; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery
• ISSN: 0302-2838
• DOI: 10.1016/j.eururo.2006.06.010

To evaluate precystectomy prediction of pT and pN stages at cystectomy. Multivariate logistic regression analyses modelled variables of 726 evaluable patients treated with radical cystectomy and bilateral pelvic lymphadenectomy. The first set of models predicted pT(3-4) stage at cystectomy, and the second set predicted pN(1-3) stages at cystectomy. Transurethral resection (TUR) predictors consisted of 2002 T stage, 1973 WHO tumour grade, presence of carcinoma in situ, age, gender, and delivery of neo-adjuvant chemotherapy. The area under the ROC curve quantified nomogram accuracy. Two hundred bootstrap resamples were used to reduce overfit bias. At TUR, 11% of patients were staged as pT(3-4) versus 42% at cystectomy. Lymph node metastases were found in 24% of patients at cystectomy (pN(1-3)). The multivariate pT(3-4) nomogram was 75.7% accurate versus 71.4% for TUR T stage. The multivariate pN(1-3) nomogram was 63.1% accurate versus 61.0% for TUR T stage. Multivariate nomograms are not perfect, but they do predict more accurately than TUR T stage alone.