以現代治療模式建立表淺性膀胱癌術後疾病進展諾模圖(nomogram)
陳昱光1、林子平1,2、張延驊1,2、郭俊逸1,2、鍾孝仁1,2、吳宏豪1,2
黃逸修1,2、林志杰1,2、范玉華1,2、黃奕燊1,2、呂仕彥3、林登龍1,2、黃志賢1,2
1台北榮民總醫院泌尿部；2 國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心； 3 台北榮民總醫院新竹分院外科部
Contemporary, single-institution nomogram predicting progression in non-muscle invasive bladder urothelial carcinoma patients
Yu-Kuang Chen1, Tzu-Ping Lin1,2, Yen-Hwa Chang1,2, Junne-Yih Kuo1,2,
Hsiao-Jen Chung1,2, Howard H.H. Wu1,2, Eric Yi-Hsiu Huang1,2,
Chih-Chieh Lin1,2, Yu-Hua Fan1,2, I-shen Huang1,2, Shih-Yen Lu3,
Alex T.L. Lin1,2, William J. Huang1,2
1 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan
3Department of Surgery, Taipei Veterans General Hospital Hsinchu branch, Hsinchu, Taiwan
Purpose
Risk models predicting prognosis in non-muscle invasive bladder cancer including European Organization for Research and Treatment of Cancer (EORTC) risk tables, and Spanish Urological Club for Oncological Treatment (CUETO) scoring model. Both were based on cohorts 20 to 40 years ago, which has different adjuvant treatment patterns from today and may be out of date. Thus, we developed a nomogram predicting disease progression with our contemporary, single institution, real-world practice cohort in Taiwan.
Materials and Methods
Among 2007 and 2015, 939 patients diagnosed with Ta or T1 bladder urothelial carcinoma (UC) after transurethral resection of bladder tumors in our institution were enrolled. Patients with short-term (<6 months) follow up, pure CIS or upper tract UC were excluded. The definition of progression was muscle invasion, metastasis or death caused by UC. After multivariable analyses, we use significant covariates for nomogram development.
Results
Four hundred twenty-four (44.3%) recurrence and 132 (13.9%) progression were documented with a 55-month mean follow-up. The mean age was 73 (±12.7) years old and there were 785 (81.9%) male patients, 103 (10.1%) concurrent CIS, 659 (64.6%) primary occurrence and 274 (26.9%) patients received adjuvant intravesical BCG instillation. Significant covariates including primary or not (HR=2.38, p<0.001), focality (HR=2.24, p<0.001), tumor stage (HR=2.01, p=0.001) and grade (HR=1.68, p=0.04), concurrent CIS (HR=1.62, p=0.033), high grade prostate urethral involvement (HR=2.21, p=0.044). Bootstrap refitting was done 200 times for internal validation and concordance index is 0.731, indicating good predicting performance. Total points of our nomogram also showed good correlation with AUA risk stratification.
Conclusions
We developed a new, convenient nomogram to predict disease progression in non-muscle invasive bladder urothelial carcinoma patients with contemporary cohort. For better utility, change in practice over time and 2004/2016 WHO histology classification migration were both take into consideration. Further external validation is required to solidify this contemporary model.