International Urology and Nephrology

, Volume 46, Issue 7, pp 1317–1323 | Cite as

Scoring system for prediction of lymph node metastasis in radical cystectomy cohort

  • Miroslav M. Stojadinović
  • Rade Prelević
  • Arso Vukićević
Urology - Original Paper

Abstract

Objectives

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.

Results

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.

Conclusions

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.

Keywords

Bladder cancer Lymph nodes metastasis Prognostic model Scoring system 

Abbreviations

AUC

Area under the receiver operating characteristic curve

BC

Bladder cancer

CI

Confidential interval

CT

Computed tomography

ePLND

Extended pelvic LND

IDI

Integrated discrimination improvement

IP

The integrated 1-specificity

IS

The integrated sensitivity

LN

Lymph node

LND

Lymph node dissection

LVI

Lymphovascular invasion

MRI

Magnetic resonance imaging

MI

Muscle-invasive

NC

Neoadjuvant chemotherapy

NPV

Negative predictive value

NRI

Net reclassification improvement

ORs

Odds ratios

pN+

Lymph node metastases

ROC

The receiver operating characteristic curve

PPV

Positive predictive value

TUR

Transurethral resection

TURBT

Transurethral resection of bladder tumor

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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Miroslav M. Stojadinović
    • 1
  • Rade Prelević
    • 2
  • Arso Vukićević
    • 3
  1. 1.Department of Urology, Clinic of Urology and NephrologyClinical Centre “Kragujevac”KragujevacSerbia
  2. 2.Clinic of UrologyMilitary Medical AcademyBelgradeSerbia
  3. 3.Faculty of EngineeringUniversity of KragujevacKragujevacSerbia

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