Scoring system for prediction of lymph node metastasis in radical cystectomy cohort
The objective of the study was to assess whether pretreatment clinical parameters combined with computed tomography can improve the prediction of lymph node metastasis in patients with bladder cancer treated with radical cystectomy.
Patients and methods
In a single-center retrospective study, demographic and clinicopathological information (initial transurethral resection [grade, stage, multiplicity of tumors, lymphovascular invasion], hydronephrosis, abdominal and pelvic computed tomography) and the presence of lymph node disease on final pathology of 183 patients with bladder cancer undergoing radical cystectomy and pelvic lymph node dissection were reviewed. Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of positive lymph nodes. Various measures for predictive ability and clinical utility were determined.
On pathological examination, 59.6 % of patients had positive lymph nodes. In a multivariable analysis, status lymph nodes on computed tomography and hydronephrosis were the most strongly associated predictors. The resultant total possible score ranged from 0 to 10, with a cut-off value of >4 points. The area under the receiver operating characteristic curve was 0.806. Relative integrated discrimination improvement was 14.3 %. In the decision curve analysis, the model provided net benefit throughout the entire range of threshold probabilities. However, the final model was roughly equivalent to using the clinical exam.
The pre-cystectomy scoring system improved the prediction of lymph node status in patients with bladder cancer. Our model represented a user-friendly staging aid, but a large multi-center study should be performed before widespread implementation.
KeywordsBladder cancer Lymph nodes metastasis Prognostic model Scoring system
Area under the receiver operating characteristic curve
Extended pelvic LND
Integrated discrimination improvement
The integrated 1-specificity
The integrated sensitivity
Lymph node dissection
Magnetic resonance imaging
Negative predictive value
Net reclassification improvement
Lymph node metastases
The receiver operating characteristic curve
Positive predictive value
Transurethral resection of bladder tumor
- 3.Youssef RF, Raj GV (2011) Lymphadenectomy in management of invasive bladder cancer. Int J Surg Oncol, 758189. Published online: Jun 16. doi:10.1155/2011/758189
- 6.Green DA, Rink M, Hansen J, et al (2012) Accurate preoperative prediction of non-organ-confined bladder urothelial carcinoma at cystectomy. BJU Int. Published online: Jul 13. doi:10.1111/j.1464-410X.2012.11370.x
- 8.Ahmadi H, Mitra AP, Abdelsayed GA, et al (2012) Principal component analysis based pre-cystectomy model to predict pathological stage in patients with clinical organ-confined bladder cancer. BJU Int. Published online: Oct 4. doi:10.1111/j.1464-410X.2012.11502.x
- 14.Sobin LH, Gospodariwicz M, Wittekind C (1973) TNM classification of malignant tumors. UICC international union against cancer, 7 edn. Wiley, London, 2009Google Scholar
- 15.Mostofi FK, Sobin LH, Torloni H (1973) Histological typing of urinary bladder tumours. World Health Organization, GenevaGoogle Scholar
- 27.May M, Burger M, Brookman-May S et al (2011) Validation of pre-cystectomy nomograms for the prediction of locally advanced urothelial bladder cancer in a multicentre study: are we able to adequately predict locally advanced tumour stages before surgery? Der Urol Ausg A 50:706–713CrossRefGoogle Scholar
- 28.Niegisch G, Lorch A, Droller MJ, Lavery HJ, Stensland KD, Albers P (2013) Neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: which patients benefit? Eur Urol. Published online: Jun 12. doi:10.1016/j.eururo.2013.06.002