Precystectomy Nomogram for Prediction of Advanced Bladder Cancer Stage

ObjectiveTo evaluate precystectomy prediction of pT and pN stages at cystectomy.MethodsMultivariate logistic regression analyses modelled variables of 726 evaluable patients treated with radical cystectomy and bilateral pelvic lymphadenectomy. The first set of models predicted pT3–4 stage at cystectomy, and the second set predicted pN1–3 stages at cystectomy. Transurethral resection (TUR) predictors consisted of 2002 T stage, 1973 WHO tumour grade, presence of carcinoma in situ, age, gender, and delivery of neo-adjuvant chemotherapy. The area under the ROC curve quantified nomogram accuracy. Two hundred bootstrap resamples were used to reduce overfit bias.ResultsAt TUR, 11% of patients were staged as pT3–4 versus 42% at cystectomy. Lymph node metastases were found in 24% of patients at cystectomy (pN1–3). The multivariate pT3–4 nomogram was 75.7% accurate versus 71.4% for TUR T stage. The multivariate pN1–3 nomogram was 63.1% accurate versus 61.0% for TUR T stage.ConclusionMultivariate nomograms are not perfect, but they do predict more accurately than TUR T stage alone.