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External validation of existing nomograms predicting lymph node metastases in cystectomized patients

  • Original Article
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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Objectives

Karakiewicz et al. and Green et al. created pre-cystectomy nomograms to predict lymph node involvement. The aim of the study was to externally validate these two nomograms in intermediate-volume institutions in Europe.

Patients and methods

Data from a Serbian single-centre cystectomy series comprising 183 patients with bladder cancer were used for the validation of two US nomograms, which were originally based on data from 726 and 201 patients, respectively. A multivariate regression model assessed the value of the clinical parameters integrated in the two nomograms. The expected predictive accuracy, calibration and clinical utility according to the nomograms were calculated.

Results

Comparison of our dataset with the previously published data shows differences in nearly all underlying risk variables. Overall, 109 (59.6 %) patients had lymph node metastases. The analysis demonstrated that hydronephrosis and status of lymph nodes on computed tomography have independent prognostic value. The performance of the nomograms deteriorated from the development set, and the predictive accuracies for the two models showed moderate discriminatory ability (61.2–69.1 %). In the decision curve analysis, only the Green et al. model predicting lymph node positivity provided net benefit.

Conclusions

The Green et al. nomogram seems applicable to patients from Europe, despite varying risk factors in the validation dataset. Acceptance of such a tool into daily clinical management may lead to more appropriate decision-making. Nevertheless, further improvement and implementation of novel statistical models with enhanced predictive accuracy is needed.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

BC:

Bladder cancer

CI:

Confidential interval

CIS:

Carcinoma in situ

CT:

Computed tomography

LN:

Lymph node

LN+ :

Positive lymph node

LR:

Logistic regression

LVI:

Lymphovascular invasion

MRI:

Magnetic resonance imaging

NC:

Neoadjuvant chemotherapy

NOC:

Non organ-confined

NPV:

Negative predictive value

OR:

Odds ratio

PLND:

Pelvic lymph node dissection

PPV:

Positive predictive value

RC:

Radical cystectomy

ROC:

Receiver operating characteristic curve

TUR:

Transurethral resection

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Acknowledgments

The authors were financially supported through a research Grant N0175014 of the Ministry of Science and Technological Development of Serbia. The authors thank the Ministry for this support.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Deparment of Urology, Clinic of Urology and Nephrology, Clinical Centre Kragujevac, Zmaj Jovina 30, 34 000, Kragujevac, Serbia

    Miroslav M. Stojadinovic

  2. Military Medical Academy, Clinic of Urology, Belgrade, Serbia

    Rade I. Prelevic

Authors
  1. Miroslav M. Stojadinovic
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  2. Rade I. Prelevic
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Correspondence to Miroslav M. Stojadinovic.

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Stojadinovic, M.M., Prelevic, R.I. External validation of existing nomograms predicting lymph node metastases in cystectomized patients. Int J Clin Oncol 20, 164–170 (2015). https://doi.org/10.1007/s10147-014-0693-3

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  • DOI: https://doi.org/10.1007/s10147-014-0693-3

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