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Development and external validation of a nomogram to predict high-grade papillary bladder cancer before first-time transurethral resection of the bladder tumor

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Abstract

Background

The aim of this study was to identify the clinical predictors related to the risk of high-grade papillary bladder cancer before first-time transurethral resection of a bladder tumor (TUR-Bt), and to develop and validate a nomogram predicting the risk of high-grade papillary bladder cancer.

Methods

A retrospective clinical study of consecutive patients who underwent first-time TUR-Bt for papillary bladder cancer was performed. Medical records were reviewed uniformly, and the following data were collected: age, sex, episodes of urinary symptoms, tumor size, number of tumors, location of the largest tumor (lateral walls, base, posterior wall, dome, and anterior wall), tumor appearance (papillary or non-papillary, pedunculated or sessile), and urinary cytology. Data from 254 patients (Group A) were used for the development of a nomogram, while data from 170 patients (Group B) were used for its external validation.

Results

High-grade papillary bladder cancer was pathologically diagnosed in 51.6 and 74.6% of Group A and Group B patients, respectively. Based on univariable analyses in Group A, macrohematuria, tumor size, multiple tumors, appearance, and positive urinary cytology were selected as variables to incorporate into a nomogram. The AUC value was 0.81 for the internal validation (Group A), and 0.78 for the external validation (Group B). This novel nomogram can predict high-grade papillary bladder cancer accurately.

Conclusions

The present nomogram can help clinicians calculate the probability in patients with bladder cancer before TUR-Bt and decide on earlier intervention and priorities for the treatment of patients diagnosed with bladder cancer.

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Funding

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Author information

Authors and Affiliations

  1. Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan

    Ken Wakai, Takanobu Utsumi, Kei Yoneda, Ryo Oka, Takumi Endo, Masashi Yano, Naoto Kamiya & Hiroyoshi Suzuki

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599-7295, USA

    Takanobu Utsumi

  3. Department of Urology, Chibaken Saiseikai Narashino Hospital, 1-1-1 Izumichou, Narashino, Chiba, 275-8580, Japan

    Masaaki Fujimura, Nobuyuki Sekita & Kazuo Mikami

  4. Department of Pathology, Chibaken Saiseikai Narashino Hospital, 1-1-1 Izumichou, Narashino, Chiba, 275-8580, Japan

    Isamu Sugano

  5. Department of Surgical Pathology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan

    Nobuyuki Hiruta

Authors
  1. Ken Wakai
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  2. Takanobu Utsumi
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  13. Hiroyoshi Suzuki
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Corresponding author

Correspondence to Takanobu Utsumi.

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Conflict of interest

Hiroyoshi Suzuki has received paid consulting from Nippon Kayaku, Takeda, Astellas, Daiichi-Sankyo, and Pfizer.

Electronic supplementary material

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10147_2018_1299_MOESM1_ESM.tif

Supplementary Fig. 1. Calibration plots with local regression non-parametric smoothing lines of the present nomograms on internal validation (a) and external validation (b). X-axis, probability of high-grade papillary bladder cancer predicted by the nomogram; Y-axis, actual proportion. Perfect prediction corresponds to a 45° line. Values above and below the 45° line represent underestimation and overestimation, respectively (TIF 274 KB)

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Wakai, K., Utsumi, T., Yoneda, K. et al. Development and external validation of a nomogram to predict high-grade papillary bladder cancer before first-time transurethral resection of the bladder tumor. Int J Clin Oncol 23, 957–964 (2018). https://doi.org/10.1007/s10147-018-1299-y

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  • DOI: https://doi.org/10.1007/s10147-018-1299-y

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