Evaluating the utility of a preoperative nomogram for predicting 90-day mortality following radical cystectomy for bladder cancer

Jennifer M. Taylor, Andrew Feifer, Caroline J. Savage, Alexandra C. Maschino, Melanie Bernstein, Harry W. Herr, S. MacHele Donat

Research output: Contribution to journalArticle

Abstract

OBJECTIVE To evaluate the performance of the Isbarn nomogram for predicting 90-day mortality following radical cystectomy in a contemporary series. PATIENTS AND METHODS We identified 1141 consecutive radical cystectomy patients treated at our institution between 1995 and 2005 with at least 90 days of follow-up. We applied the published nomogram to our cohort, determining its discrimination, with the area under the receiver operating characteristic curve (AUC), and calibration. We further compared it with a simple model using age and the Charlson comorbidity score. RESULTS Our cohort was similar to that used to develop the Isbarn nomogram in terms of age, gender, grade and histology; however, we observed a higher organ-confined (pT2, N0) rate (52% vs 24%) and a lower overall 90-day mortality rate [2.8% (95% confidence interval 1.9%, 3.9%) vs 3.9%]. The Isbarn nomogram predicted individual 90-day mortality in our cohort with moderate discrimination [AUC 73.8% (95% confidence interval 64.4%, 83.2%)]. In comparison, a model using age and Charlson score alone had a bootstrap-corrected AUC of 70.2% (95% confidence interval 67.2%, 75.4%). CONCLUSIONS The Isbarn nomogram showed moderate discrimination in our cohort; however, the exclusion of important preoperative comorbidity variables and the use of postoperative pathological stage limit its utility in the preoperative setting. The use of a simple model combining age and Charlson score yielded similar discriminatory ability and underscores the significance of individual patient variables in predicting outcomes. An accurate tool for predicting postoperative morbidity/mortality following radical cystectomy would be valuable for treatment planning and counselling. Future nomogram design should be based on preoperative variables including individual risk factors, such as comorbidities.

Original languageEnglish (US)
Pages (from-to)855-859
Number of pages5
JournalBJU International
Volume109
Issue number6
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Nomograms
Cystectomy
Urinary Bladder Neoplasms
Mortality
Area Under Curve
Comorbidity
Confidence Intervals
Aptitude
ROC Curve
Calibration
Counseling
Histology
Morbidity

Keywords

  • bladder cancer
  • cystectomy
  • mortality
  • nomograms
  • postoperative complications
  • risk assessment

ASJC Scopus subject areas

  • Urology

Cite this

Taylor, J. M., Feifer, A., Savage, C. J., Maschino, A. C., Bernstein, M., Herr, H. W., & Donat, S. M. (2012). Evaluating the utility of a preoperative nomogram for predicting 90-day mortality following radical cystectomy for bladder cancer. BJU International, 109(6), 855-859. https://doi.org/10.1111/j.1464-410X.2011.10391.x

Evaluating the utility of a preoperative nomogram for predicting 90-day mortality following radical cystectomy for bladder cancer. / Taylor, Jennifer M.; Feifer, Andrew; Savage, Caroline J.; Maschino, Alexandra C.; Bernstein, Melanie; Herr, Harry W.; Donat, S. MacHele.

In: BJU International, Vol. 109, No. 6, 03.2012, p. 855-859.

Research output: Contribution to journalArticle

Taylor, Jennifer M. ; Feifer, Andrew ; Savage, Caroline J. ; Maschino, Alexandra C. ; Bernstein, Melanie ; Herr, Harry W. ; Donat, S. MacHele. / Evaluating the utility of a preoperative nomogram for predicting 90-day mortality following radical cystectomy for bladder cancer. In: BJU International. 2012 ; Vol. 109, No. 6. pp. 855-859.
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abstract = "OBJECTIVE To evaluate the performance of the Isbarn nomogram for predicting 90-day mortality following radical cystectomy in a contemporary series. PATIENTS AND METHODS We identified 1141 consecutive radical cystectomy patients treated at our institution between 1995 and 2005 with at least 90 days of follow-up. We applied the published nomogram to our cohort, determining its discrimination, with the area under the receiver operating characteristic curve (AUC), and calibration. We further compared it with a simple model using age and the Charlson comorbidity score. RESULTS Our cohort was similar to that used to develop the Isbarn nomogram in terms of age, gender, grade and histology; however, we observed a higher organ-confined (pT2, N0) rate (52{\%} vs 24{\%}) and a lower overall 90-day mortality rate [2.8{\%} (95{\%} confidence interval 1.9{\%}, 3.9{\%}) vs 3.9{\%}]. The Isbarn nomogram predicted individual 90-day mortality in our cohort with moderate discrimination [AUC 73.8{\%} (95{\%} confidence interval 64.4{\%}, 83.2{\%})]. In comparison, a model using age and Charlson score alone had a bootstrap-corrected AUC of 70.2{\%} (95{\%} confidence interval 67.2{\%}, 75.4{\%}). CONCLUSIONS The Isbarn nomogram showed moderate discrimination in our cohort; however, the exclusion of important preoperative comorbidity variables and the use of postoperative pathological stage limit its utility in the preoperative setting. The use of a simple model combining age and Charlson score yielded similar discriminatory ability and underscores the significance of individual patient variables in predicting outcomes. An accurate tool for predicting postoperative morbidity/mortality following radical cystectomy would be valuable for treatment planning and counselling. Future nomogram design should be based on preoperative variables including individual risk factors, such as comorbidities.",
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AU - Taylor, Jennifer M.

AU - Feifer, Andrew

AU - Savage, Caroline J.

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AU - Bernstein, Melanie

AU - Herr, Harry W.

AU - Donat, S. MacHele

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N2 - OBJECTIVE To evaluate the performance of the Isbarn nomogram for predicting 90-day mortality following radical cystectomy in a contemporary series. PATIENTS AND METHODS We identified 1141 consecutive radical cystectomy patients treated at our institution between 1995 and 2005 with at least 90 days of follow-up. We applied the published nomogram to our cohort, determining its discrimination, with the area under the receiver operating characteristic curve (AUC), and calibration. We further compared it with a simple model using age and the Charlson comorbidity score. RESULTS Our cohort was similar to that used to develop the Isbarn nomogram in terms of age, gender, grade and histology; however, we observed a higher organ-confined (pT2, N0) rate (52% vs 24%) and a lower overall 90-day mortality rate [2.8% (95% confidence interval 1.9%, 3.9%) vs 3.9%]. The Isbarn nomogram predicted individual 90-day mortality in our cohort with moderate discrimination [AUC 73.8% (95% confidence interval 64.4%, 83.2%)]. In comparison, a model using age and Charlson score alone had a bootstrap-corrected AUC of 70.2% (95% confidence interval 67.2%, 75.4%). CONCLUSIONS The Isbarn nomogram showed moderate discrimination in our cohort; however, the exclusion of important preoperative comorbidity variables and the use of postoperative pathological stage limit its utility in the preoperative setting. The use of a simple model combining age and Charlson score yielded similar discriminatory ability and underscores the significance of individual patient variables in predicting outcomes. An accurate tool for predicting postoperative morbidity/mortality following radical cystectomy would be valuable for treatment planning and counselling. Future nomogram design should be based on preoperative variables including individual risk factors, such as comorbidities.

AB - OBJECTIVE To evaluate the performance of the Isbarn nomogram for predicting 90-day mortality following radical cystectomy in a contemporary series. PATIENTS AND METHODS We identified 1141 consecutive radical cystectomy patients treated at our institution between 1995 and 2005 with at least 90 days of follow-up. We applied the published nomogram to our cohort, determining its discrimination, with the area under the receiver operating characteristic curve (AUC), and calibration. We further compared it with a simple model using age and the Charlson comorbidity score. RESULTS Our cohort was similar to that used to develop the Isbarn nomogram in terms of age, gender, grade and histology; however, we observed a higher organ-confined (pT2, N0) rate (52% vs 24%) and a lower overall 90-day mortality rate [2.8% (95% confidence interval 1.9%, 3.9%) vs 3.9%]. The Isbarn nomogram predicted individual 90-day mortality in our cohort with moderate discrimination [AUC 73.8% (95% confidence interval 64.4%, 83.2%)]. In comparison, a model using age and Charlson score alone had a bootstrap-corrected AUC of 70.2% (95% confidence interval 67.2%, 75.4%). CONCLUSIONS The Isbarn nomogram showed moderate discrimination in our cohort; however, the exclusion of important preoperative comorbidity variables and the use of postoperative pathological stage limit its utility in the preoperative setting. The use of a simple model combining age and Charlson score yielded similar discriminatory ability and underscores the significance of individual patient variables in predicting outcomes. An accurate tool for predicting postoperative morbidity/mortality following radical cystectomy would be valuable for treatment planning and counselling. Future nomogram design should be based on preoperative variables including individual risk factors, such as comorbidities.

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KW - postoperative complications

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