Development and Validation of a Prognostic Nomogram for Predicting Cancer-Specific Survival in Patients With Lymph Node Positive Bladder Cancer: A Study Based on SEER Database.

Xiangpeng Zhan,Luyao Chen,Xiaoqiang Liu,Ming Jiang,Bin Fu,Wen Deng

doi:10.3389/fonc.2022.789028

Abstract

PurposeTo construct a prognostic model to predict the cancer-specific survival (CSS) for bladder cancer patients with lymph node-positive.Patients and MethodsWe enrolled 2,050 patients diagnosed with lymph node-positive bladder cancer from the Surveillance Epidemiology and End Results (SEER) database (2004–2015). All patients were randomly split into development cohort (n = 1,438) and validation cohort (n = 612) at a ratio of 7:3. The univariate and multivariate Cox regression analysis were performed to identify prognostic factors. A nomogram predicting CSS was established based on the results of multivariate Cox analysis. Its performance was evaluated by calibration curves, the receiver operating characteristic (ROC) curves, and the concordance index (C-index). Internal verification was performed in the validation cohort. The Kaplan–Meier method with the log-rank test was applied in the different risk groups.ResultsThe nomogram incorporated summary stage, tumor size, chemotherapy, regional nodes examined and positive lymph nodes. The C-index of the nomogram in the development cohort was 0.716 (0.707–0.725), while the value of the C-index was 0.691 (0.689–0.693) in the validation cohort. The AUC of the nomogram was 0.803 for 3-year and 0.854 for 5-year in the development cohort, while was 0.773 for 3-year and 0.809 for 5-year in the validation cohort. Calibration plots for 3-year and 5-year CSS showed good concordance. Significant differences were observed between high, medium, and low risk groups (P <0.001).ConclusionsWe have established a prognostic nomogram providing an accurate individualized probability of cancer-specific survival in bladder cancer patients with lymph node-positive. The nomogram could contribute to patient counseling, follow-up scheduling, and selection of treatment.

Highlights

Bladder cancer (BC) is a common malignancy globally, with an estimated 500,000 new cases and 200,000 deaths worldwide in 2018 [1, 2]
The nomogram could contribute to patient counseling, follow-up scheduling, and selection of treatment
2,050 patients with lymph node-positive were enrolled in our study, and 1,438 patients (70%) were distributed into the development cohort while 612 patients (30%) into the validation cohort

Summary

Introduction

Bladder cancer (BC) is a common malignancy globally, with an estimated 500,000 new cases and 200,000 deaths worldwide in 2018 [1, 2]. Bladder cancer is a severe and heterogeneous disease with a poor prognosis, especially for those patients with lymph node-positive [3]. A retrospective study showed that approximately 25–30% of BC patients undergoing radical cystectomy presented with lymph node-positive after pathologic examination. Only a 25% disease-free survival rate was observed in these patients [4]. Several retrospective studies had confirmed the poor prognosis of the higher recurrence and poorer survival rate in node-positive patients compared with those without [4,5,6,7]. A survey demonstrated that up to 70–80% of node-positive patients experienced disease recurrence, while this data was only 30% in patients with negative pathological nodes

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