Abstract
PurposeThis study aims to develop and validate a nomogram to predict lymph node (LN) metastasis preoperatively in patients with T1 high-grade urothelial carcinoma.MethodsWe retrospectively evaluated the data of 2,689 patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC) and bilateral lymphadenectomy in two medical centers. Eventually, 412 patients with T1 high-grade urothelial carcinoma were enrolled in the primary cohort to develop a prognostic nomogram designed to predict LN status. An independent validation cohort (containing 783 consecutive patients during the same period) was subjected to validate the predicting model. Binary regression analysis was used to develop the predicting nomogram. We assessed the performance of the nomogram concerning its clinical usefulness, calibration, and discrimination.ResultsOverall, 69 (16.75%), and 135 (17.24%) patients had LN metastasis in the primary cohort and external validation cohort, respectively. The final nomogram included information on tumor number, tumor size, lymphovascular invasion (LVI), fibrinogen, and monocyte-to-lymphocyte ratio (MLR). The nomogram showed good predictive accuracy and calibration with a concordance index in the primary cohort of 0.853. The application of the nomogram in the external validation cohort still gave good discrimination (C-index, 0.845) and good calibration. The analysis of the decision curve shows that the nomogram has clinical application value.ConclusionThe nomogram that incorporated the tumor number, tumor size, LVI, fibrinogen, and MLR showed favorable predictive accuracy for LN metastasis. It may be conveniently used to predict LN metastasis in patients with T1 high-grade urothelial carcinoma and be helpful in guiding treatment decisions.
Highlights
Urothelial carcinoma of the bladder (UCB) is the ninth most common tumor worldwide [1]
The area under the curve (AUC) of the receiver operating characteristic (ROC) curve (Figure 3) of the nomogram was 0.853, indicating that the nomogram is powerful to differentiate lymph node (LN) metastasis
Brunocilla et al evaluated the role of PET-CT in the preoperative evaluation of the nodal involvement of patients with BC suitable for radical cystectomy (RC) and found that PET-CT showed a sensitivity of 42% and a specificity of 84%, whereas contrast-enhanced CT showed a sensitivity of 14% and a specificity of 89% [24]
Summary
Urothelial carcinoma of the bladder (UCB) is the ninth most common tumor worldwide [1]. To date, extended pelvic lymph node (LN) dissection is suggested in some clinical trials for UCB patients with LN metastasis. It can prolong the lifetime of these patients [4, 5]. Some patients with T1 high-grade bladder cancer have a low risk of metastasis and progression, and conservative treatment can be tried. In these cases, RC may be an overtreatment [7]. Current evidence demonstrate that clinicopathological and molecular risk classifiers together may help to select the optimal management strategy for each patient with T1 high-grade disease [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
