Abstract
PurposeTo externally validate models to predict LN metastsis; Karakiewicz nomogram, clinical nodal staging score (cNSS), and pathologic nodal staging score (pNSS) using a different cohortMaterials and MethodsClinicopathologic data from 500 patients who underwent radical cystectomy and pelvic lymphadenectomy were analyzed. The overall predictive values of models were compared with the criteria of overall performance, discrimination, calibration, and clinical usefulness.ResultsPresence of pN+ stages was recorded in 117 patients (23.4%). Agreement between clinical and pathologic stage was noted in 174 (34.8%). Based on Nagelkerke’s peudo-R2 and brier score, pNSS demonstrated best overall performance. Area under the receiver operating characteristics curve, showed that pNSS had the best discriminatory ability. In all models, calibration was on average correct (calibration-in-the-large coefficient = zero). On decision curve analysis, pNSS performed better than other models across a wide range of threshold probabilities.ConclusionsWhen compared to pNSS, current precystectomy models such as the Karakiewicz nomogram and cNSS cannot predict the probability of LN metastases accurately. The findings suggest that the application of pNSS to Asian patients is feasible.
Highlights
Radical cystectomy with lymph node (LN) dissection constitutes the standard treatment for muscle invasive and refractory nonmuscle invasive bladder cancer
Presence of pN+ stages was recorded in 117 patients (23.4%)
When compared to pathologic nodal staging score (pNSS), current precystectomy models such as the Karakiewicz nomogram and clinical nodal staging score (cNSS) cannot predict the probability of LN metastases accurately
Summary
Radical cystectomy with lymph node (LN) dissection constitutes the standard treatment for muscle invasive and refractory nonmuscle invasive bladder cancer. As nodal disease is a powerful predictor of cancer-specific survival [1], knowledge of nodal status influences patient counseling and, more importantly, clinical decision making regarding follow-up scheduling and adjuvant chemotherapy [2,3]. Karakiewicz et al [4] developed a multivariate nomogram with the intent of accurately predicting presence of LN metastases at cystectomy. Some investigators hypothesized that true nodal status could be accurately predicted based on the number of LNs examined and clinical or pathologic features; clinical nodal staging score (cNSS) [5] and pathologic nodal staging score (pNSS) [6] were developed to predict the probability that a patient with pathologically confirmed negative LNs is free of missed LN metastasis. The aim of the present study was to externally validate the Karakiewicz nomogram, cNSS, and pNSS using a cohort from three centers from different countries.
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