Neurofuzzy Modeling to Determine Recurrence Risk Following Radical Cystectomy for Nonmetastatic Urothelial Carcinoma of the Bladder
Neurofuzzy Modeling to Determine Recurrence Risk Following Radical Cystectomy for Nonmetastatic Urothelial Carcinoma of the Bladder
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DOI：
10.1158/1078-0432.ccr-08-1960
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发表时间：
2009-05-01
影响因子：
11.5
通讯作者：
Hamdy, Freddie C.
中科院分区：
文献类型：
--
作者：
Catto, James W. F.;Abbod, Maysam F.;Hamdy, Freddie C.
目的：40% 的膀胱癌患者在根治性膀胱切除术 (RC) 和盆腔淋巴结切除术 (PLND) 后出现复发。尽管辅助化疗可以减少复发，但这种治疗的毒性和低反应率限制了其在高风险患者中的使用。我们开发了一种神经模糊模型 (NFM)，用于预测通常不接受辅助化疗的患者在 RC 和 PLND 后的疾病复发。实验设计：该研究包括 1,034 名接受 RC 和 PLND 治疗的膀胱尿路上皮癌患者。 425 名患者因淋巴结转移和/或化疗而被排除。对于其余 609 名患者，我们获得了与其肿瘤相关的完整临床病理数据。我们训练、测试和验证了两个 NFM，它们可以预测 RC 后复发的风险（分类器）和时间（预测器）。我们测量了模型在不同术后时间点的准确性。结果：172 名 (28%) 患者出现癌症复发。中位随访时间为 72.7 个月，我们的分类器 NFM 识别复发的准确度为 0.84（一致性指数 0.92，敏感性 0.81，特异性 0.85），并且具有出色的校准。这比两个预测列线图（准确度分别为 0.72 和 0.74）要好。预测器 NFM 确定肿瘤复发的时间，中位误差为 8.15 个月。结论：我们开发了一种准确且经过良好校准的模型，用于识别非转移性膀胱尿路上皮癌患者 RC 和 PLND 后的疾病复发。它似乎优于其他可用的预测方法，可用于识别可能从辅助化疗中受益的患者。
Purpose: Bladder cancer recurrence occurs in 40% of patients following radical cystectomy (RC) and pelvic lymphadenectomy (PLND). Although recurrence can be reduced with adjuvant chemotherapy, the toxicity and low response rates of this treatment restrict its use to patients at highest risk. We developed a neurofuzzy model (NFM) to predict disease recurrence following RC and PLND in patients who are not usually administered adjuvant chemotherapy.Experimental Design: The study comprised 1,034 patients treated with RC and PLND for bladder urothelial carcinoma. Four hundred twenty-five patients were excluded due to lymph node metastases and/or administration of chemotherapy. For the remaining 609 patients, we obtained complete clinicopathologic data relating to their tumor. We trained, tested, and validated two NFMs that predicted risk (Classifier) and timing (Predictor) of post-RC recurrence. We measured the accuracy of our model at various postoperative time points.Results: Cancer recurrence occurred in 172 (28%) patients. With a median follow-up of 72.7 months, our Classifier NFM identified recurrence with an accuracy of 0.84 (concordance index 0.92, sensitivity 0.81, and specificity 0.85) and an excellent calibration. This was better than two predictive nomograms (0.72 and 0.74 accuracies). The Predictor NFMs identified the timing of tumor recurrence with a median error of 8.15 months.Conclusions: We have developed an accurate and well-calibrated model to identify disease recurrence following RC and PLND in patients with nonmetastatic bladder urothelial carcinoma. It seems superior to other available predictive methods and could be used to identify patients who would potentially benefit from adjuvant chemotherapy.