Scoring system development for prediction of extravesical bladder cancer
Background/Aim. Staging of bladder cancer is crucial for optimal management of the disease. However, clinical staging is not perfectly accurate. The aim of this study was to derive a simple scoring system in prediction of pathological advanced muscle-invasive bladder cancer (MIBC). Methods....
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2014-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501400040P.pdf |
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| Summary: | Background/Aim. Staging of bladder cancer is crucial for optimal management
of the disease. However, clinical staging is not perfectly accurate. The aim
of this study was to derive a simple scoring system in prediction of
pathological advanced muscle-invasive bladder cancer (MIBC). Methods.
Logistic regression and bootstrap methods were used to create an integer
score for estimating the risk in prediction of pathological advanced MIBC
using precystectomy clinicopathological data: demographic, initial
transurethral resection (TUR) [grade, stage, multiplicity of tumors,
lymphovascular invasion (LVI)], hydronephrosis, abdominal and pelvic CT
radiography (size of the tumor, tumor base width), and pathological stage
after radical cystectomy (RC). Advanced MIBC in surgical specimen was
defined as pT3-4 tumor. Receiving operating characteristic (ROC) curve
quantified the area under curve (AUC) as predictive accuracy. Clinical
usefulness was assessed by using decision curve analysis. Results. This
single-center retrospective study included 233 adult patients with BC
undergoing RC at the Military Medical Academy, Belgrade. Organ confined
disease was observed in 101 (43.3%) patients, and 132 (56.7%) had advanced
MIBC. In multivariable analysis, 3 risk factors most strongly associated
with advanced MIBC: grade of initial TUR [odds ratio (OR) = 4.7], LVI (OR =
2), and hydronephrosis (OR = 3.9). The resultant total possible score ranged
from 0 to 15, with the cut-off value of > 8 points, the AUC was 0.795,
showing good discriminatory ability. The model showed excellent calibration.
Decision curve analysis showed a net benefit across all threshold
probabilities and clinical usefulness of the model. Conclusion. We developed
a unique scoring system which could assist in predicting advanced MIBC in
patients before RC. The scoring system showed good performance
characteristics and introducing of such a tool into daily clinical
decision-making may lead to more appropriate integration of perioperative
chemotherapy. Clinical value of this model needs to be further assessed in
external validation cohorts. [Projekat Ministarstva nauke Republike Srbije,
br. N0175014] |
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| ISSN: | 0042-8450 |