Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder
Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder
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DOI：
10.1016/j.juro.2006.06.025
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发表时间：
2006-10-01
影响因子：
6.6
通讯作者：
Lerner, Seth P.
中科院分区：
文献类型：
--
作者：
Karakiewicz, Pierre I.;Shariat, Shahrokh F.;Lerner, Seth P.
目的：美国癌症分期联合委员会代表了预测浸润性膀胱癌患者根治性膀胱切除术后复发的金标准。我们测试了以下假设：当病理肿瘤和淋巴结分期信息与预后列线图中的其他临床和病理变量相结合时，基于美国癌症联合委员会分期的预测可能会得到改善。材料和方法：我们使用 Cox 比例风险回归分析对 728 名接受根治性膀胱切除术和双侧骨盆治疗的膀胱移行细胞癌患者的变量进行建模 3 个参与机构之一进行淋巴结切除术。标准预测因子 pT 和 pN 还包括年龄、性别、膀胱切除术时的肿瘤分级、是否存在淋巴血管侵犯、膀胱切除标本中是否存在原位癌、新辅助化疗、辅助化疗和辅助放疗。一致性指数用于量化基于列线图的回归系数的准确性。总共使用了 200 次引导重采样来减少过度拟合偏差并进行内部验证。使用校准图以图形方式探索多变量列线图的性能特征。结果：随访时间范围为 0.1 至 183.4 个月（中位数 24.9，平均 36.4）。 249 名 (34.2%) 患者出现复发，中位复发时间为 108 个月（范围 0.8 至 131.9）。膀胱切除术后 2 年、5 年和 8 年的精算无复发概率分别为 69.6% (95% CI 65.8%-73.0%)、60.2% (55.8%-64.3%) 和 52.9% (47.3%-58.1%)。美国癌症联合委员会基于分期的预测的 200 个引导校正预测准确度为 0.748。当年龄、淋巴管侵犯、原位癌、新辅助化疗、辅助化疗和辅助放疗添加到病理分期信息并在列线图中使用时，准确度提高了 3.2% (0.780)。 结论：预测膀胱切除术后膀胱癌复发的列线图比美国癌症联合委员会基于分期的预测准确度高 3.2%。此外，列线图方法结合了多种优点，例如可以轻松准确地估计膀胱切除术后关键点的个体复发概率，这是所有患者都应该知道的，所有治疗医生都需要知道的。
Purpose: American Joint Committee on Cancer staging represents the gold standard for prediction of recurrence after radical cystectomy in patients with invasive bladder cancer. We tested the hypothesis that American Joint Committee on Cancer stage based predictions may be improved when pathological tumor and node stage information is combined with additional clinical and pathological variables within a prognostic nomogram.Materials and Methods: We used Cox proportional hazards regression analysis to model variables of 728 patients with transitional cell carcinoma of the bladder treated with radical cystectomy and bilateral pelvic lymphadenectomy at 1 of 3 participating institutions. Standard predictors, pT and pN, were complemented by age, gender, tumor grade at cystectomy, presence of lymphovascular invasion, presence of carcinoma in situ in the cystectomy specimen, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiotherapy. The concordance index was used to quantify the accuracy of regression coefficient based nomograms. A total of 200 bootstrap resamples were used to reduce overfit bias and for internal validation. Calibration plots were used to graphically explore the performance characteristics of the multivariate nomogram.Results: Followup ranged from 0.1 to 183.4 months (median 24.9, mean 36.4). Recurrence was recorded in 249 (34.2%) patients with a median time to recurrence of 108 months (range 0.8 to 131.9). Actuarial recurrence-free probabilities were 69.6% (95% CI 65.8%-73.0%), 60.2% (55.8%-64.3%) and 52.9% (47.3%-58.1%) at 2, 5 and 8 years after cystectomy, respectively. Two-hundred bootstrap corrected predictive accuracy of American Joint Committee on Cancer stage based predictions was 0.748. Accuracy increased by 3.2% (0.780) when age, lymphovascular invasion, carcinoma in situ, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiotherapy were added to pathological stage information and used within a nomogram.Conclusions: A nomogram predicting bladder cancer recurrence after cystectomy is 3.2% more accurate than American Joint Committee on Cancer stage based predictions. Moreover, a nomogram approach combines several advantages such as easy and precise estimation of individual recurrence probability at key points after cystectomy, which all patients deserve to know and all treating physicians need to know.