Abstract
BackgroundThis study aimed to establish and validate a nomogram for predicting brain metastasis in patients with bladder cancer (BCa) and assess various treatment modalities using a primary cohort comprising 234 patients with clinicopathologically-confirmed BCa from 2004 to 2015 in the National Cancer Database.MethodsMachine learning method and Cox model were used for nomogram construction. For BCa patients with brain metastasis, surgery of the primary site, chemotherapy, radiation therapy, palliative care, brain confinement of metastatic sites, and the Charlson/Deyo Score were predictive features identified for building the nomogram.ResultsFor the original 169 patients considered in the model, the areas under the receiver operating characteristic curve (AUC) were 0.823 (95% CI 0.758–0.889, P < 0.001) and 0.854 (95% CI 0.785–0.924, P < 0.001) for 0.5- and 1-year overall survival respectively. In the validation cohort, the nomogram displayed similar AUCs of 0.838 (95% CI 0.738–0.937, P < 0.001) and 0.809 (95% CI 0.680–0.939, P < 0.001), respectively. The high and low risk groups had median survivals of 1.91 and 5.09 months for the training cohort and 1.68 and 8.05 months for the validation set, respectively (both P < 0.0001).ConclusionsOur prognostic nomogram provides a useful tool for overall survival prediction as well as assessing the risk and optimal treatment for BCa patients with brain metastasis.
Highlights
This study aimed to establish and validate a nomogram for predicting brain metastasis in patients with bladder cancer (BCa) and assess various treatment modalities using a primary cohort comprising 234 patients with clinicopathologically-confirmed BCa from 2004 to 2015 in the National Cancer Database
10–15% of BCa patients already have metastasis at initial diagnosis and 15–30% high-grade BCa will eventually progress to advanced disease and lead to poor prognosis [2]
Clinicopathologic characteristics During the study procedure, 268 consecutive BCa patients with brain-involvement were identified from the National Cancer Database (NCDB)
Summary
This study aimed to establish and validate a nomogram for predicting brain metastasis in patients with bladder cancer (BCa) and assess various treatment modalities using a primary cohort comprising 234 patients with clinicopathologically-confirmed BCa from 2004 to 2015 in the National Cancer Database. 10–15% of BCa patients already have metastasis at initial diagnosis and 15–30% high-grade BCa will eventually progress to advanced disease and lead to poor prognosis [2]. Despite an initial response to chemotherapy, patients with non-organ-confined disease fail to attain satisfactory survival [3]. According to a previous population-based study of the SEER database, only 4.1% (76/1862) BCa patients had brain metastases in a cohort of 1862 patients with metastatic sites [5].
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