Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer
Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer
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DOI：
10.1200/jco.2005.05.3884
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发表时间：
2006-08-20
影响因子：
45.3
通讯作者：
Kikuchi, Eiji
中科院分区：
文献类型：
--
作者：
Bochner, Bernard H.;Dalbagni, Guido;Kikuchi, Eiji
目的根治性膀胱切除术和盆腔淋巴结切除术（PLND）仍然是局部和区域晚期浸润性膀胱癌的标准治疗方法。我们已经建立了一个国际膀胱癌数据库，来自膀胱癌管理的卓越中心，包括接受根治性膀胱癌和PLND治疗的患者。本研究的目标是发展的预后结果诺模图预测5年后的疾病复发风险根治cycliferation.Patients和方法机构根治cycliferationdatabases包含膀胱癌患者的详细信息，从全球12个卓越的中心。收集了9,000多名术后患者的数据，并将其合并到一个关系数据库中，该数据库包含患者特征、术前和术后标本的病理细节以及复发和生存状态。所有选定的研究标准的可用信息的患者包括在最终的预后诺模图的形成，旨在预测5年无进展probability.Results的最终诺模图包括患者的年龄，性别，从诊断到手术的时间，病理肿瘤分期和分级，肿瘤组织学亚型，区域淋巴结状态的信息。构建的国际诺模图的预测精度（一致性指数0.75）明显优于标准的美国癌症联合委员会TNM（一致性指数，0.68; P < .001）或标准病理亚组（一致性指数，0.62;结论我们建立了一个预测膀胱癌根治术后复发风险的国际膀胱癌诺模图。诺模图优于使用标准病理亚组的预后模型，并应提高我们对膀胱癌手术治疗后患者提供准确风险评估的能力。
Purpose Radical cystectomy and pelvic lymphadenectomy (PLND) remains the standard treatment for localized and regionally advanced invasive bladder cancers. We have constructed an international bladder cancer database from centers of excellence in the management of bladder cancer consisting of patients treated with radical cystectomy and PLND. The goal of this study was the development of a prognostic outcomes nomogram to predict the 5-year disease recurrence risk after radical cystectomy.Patients and Methods Institutional radical cystectomy databases containing detailed information on bladder cancer patients were obtained from 12 centers of excellence worldwide. Data were Collected on more than 9,000 postoperative patients and combined into a relational database formatted with patient characteristics, pathologic details of the pre- and postcystectomy specimens, and recurrence and survival status. Patients with available information for all selected study criteria were included in the formation of the final prognostic nomogram designed to predict 5-year progression-free probability.Results The final nomogram included information on patient age, sex, time from diagnosis to surgery, pathologic tumor stage and grade, tumor histologic subtype, and regional lymph node status. The predictive accuracy of the constructed international nomogram (concordance index, 0.75) was significantly better than standard American Joint Committee on Cancer TNM (Concordance index, 0.68; P < .001) or standard pathologic subgroupings (concordance index, 0.62; P < .001).Conclusion We have developed an international bladder cancer nomogram predicting recurrence risk after radical cystectomy for bladder cancer. The nomogram outperformed prognostic models that use standard pathologic subgroupings and should improve our ability to provide accurate risk assessments to patients after the surgical management of bladder cancer.