Novel nomograms to predict recurrence and progression in primary non-muscle-invasive bladder cancer: validation of predictive efficacy in comparison with European Organization of Research and Treatment of Cancer scoring system
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To develop and validate novel nomograms to predict recurrence and progression after transurethral resection of bladder tumor (TURBT) in Korean patients with non-muscle-invasive bladder cancer (NMIBC).
We retrospectively analyzed the clinical data on 970 newly diagnosed NMIBC patients after TURBT between 2000 and 2013 in a single institution. We used multivariate Cox proportional hazard models to identify the significant predictors of recurrence and progression, which resulted in the construction of the nomograms predicting the 5-year probability of recurrence and progression. We internally validated the nomograms using the area under the receiver-operating characteristics’ curves and calibration plots. In addition, the clinical usefulness of each nomogram was assessed and compared with that of the European Organization of Research and Treatment of Cancer (EORTC)-scoring system using decision curve analysis (DCA).
The significant factors related to recurrence were gross hematuria at diagnosis, previous or concomitant upper urinary tract urothelial carcinoma (UTUC), pT1 tumor, high tumor grade, multiple tumors, and intravesical therapy. The significant predictors of progression were previous or concomitant UTUC, pT1 tumor, high tumor grade, carcinoma in situ, and lymphovascular invasion. The 5-year predictive accuracy of each nomogram was 65% for recurrence and 70% for progression, respectively. Compared with the EORTC-scoring system, the nomograms were generally well calibrated. On DCA, each nomogram presented better net benefit gains than did the EORTC-scoring system across a wide range of threshold probabilities.
Our novel nomograms are not completely accurate, but they show a reasonable level of discriminative ability, adequate calibration, and meaningful net benefit gain for the prediction of recurrence and progression after TURBT in Korean NMIBC patients. Additional external validation will be required to generalize the nomograms which we developed.
KeywordsUrinary bladder neoplasms Recurrence Disease progression Nomograms
This study was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (Grant number: 2018R1C1B5086339).
Conception and design: HSK, JHK, CWJ, CK, and HHK. Data acquisition: HSK and JHK. Data analysis and interpretation: JHK and HSK. Manuscript drafting: HSK and JHK. Critical revision of the manuscript for scientific and factual content: JHK and HSK. Statistical analysis: HSK and JHK. Supervision: HSK, JHK, CWJ, CK, and HHK.
Compliance with ethical standards
Conflict of interest
There is no any conflict of interest to disclose among all authors.
Research involving human participants and/or animals
Prior to the initiation of the study, the use of patients’ data in this study was approved from institutional review board (IRB) of Seoul National University Hospital (IRB number: H-1506-063-679).
Owing to the retrospective feature of this study, the requirement for obtaining written informed consent from each patient was waived by the IRB of Seoul National University Hospital.
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