To externally validate three previously published nomograms for predicting recurrence (J Urol 176: 1354, 2006), cancer-specific survival, and overall survival (Clin Cancer Res 12(22): 6663, 2006) following radical cystectomy and pelvic lymph node dissection for urothelial carcinoma of the urinary bladder.
Two surgeons from a single institution performed 197 consecutive RC and PLND for bladder cancer from January 2003 to September 2009. Twenty-three patients were excluded. Examined parameters were those used in the original nomograms, which included age, gender, pathological T-stage, N-stage, tumor grade, presence of carcinoma in situ and lymphovascular invasion, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiation therapy. Nomogram predictions were compared to actuarial outcomes, and predictive accuracy was quantified using measures of discrimination and calibration.
At the time of analysis, 34 patients had experienced recurrence. Of these, 28 patients died of disease, and 6 patients were currently alive with disease. Discrimination at 2, 5 and 8 years for recurrence was 0. 776, 0. 809, and 0. 794, respectively; for cancer-specific survival was 0. 822, 0. 840, and 0. 849; and for overall survival was 0. 812, 0. 820, and 0. 825, respectively. Calibration plots revealed nomogram overestimation of all three endpoints.
The nomograms for bladder cancer recurrence, cancer-specific survival, and overall survival following RC and PLND performed well in our series, with accuracy comparable to that in the original series. The utilization of nomogram predictions should be further explored in clinical trials to assess their impact on patient care in clinical practice.
The Journal of urology. 2015 Sep 04 [Epub ahead of print]
Michael Brooks, Guilherme Godoy, Maxine Sun, Shahrokh F Shariat, Gilad E Amiel, Seth P Lerner
Scott Department of Urology, Baylor College of Medicine, Houston, TX. , Scott Department of Urology, Baylor College of Medicine, Houston, TX. , University of Montreal Health Center, Montreal, Québec, Canada; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Medicine, Boston, MA. , Bladder Cancer Research Consortium; Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; Weil Medical College Cornell University, New York, NY. , Scott Department of Urology, Baylor College of Medicine, Houston, TX; Bladder Cancer Research Consortium; Department of Urology, Rambam Health Care Campus, Haifa, Isreal. , Scott Department of Urology, Baylor College of Medicine, Houston, TX; Bladder Cancer Research Consortium.