Nomograms provide improved accuracy for predicting survival after radical cystectomy

Shahrokh F. Shariat, Pierre I. Karakiewicz, Ganesh S. Palapattu, Gilad E. Amiel, Yair Lotan, Craig G. Rogers, Amnon Vazina, Patrick J. Bastian, Amit Gupta, Arthur I. Sagalowsky, Mark Schoenberg, Seth P. Lerner

Research output: Contribution to journalArticle

Abstract

Aims: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer - specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging. Methods: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma. Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT). Two hundred bootstrap resamples were used to reduce overfit bias and for internal validation. Results: During a mean follow-up of 36.4 months, 290 of 731 (39.7%) patients died; 106 of 290 patients (67.6%) died of bladder cancer. Actuarial all-cause survival estimates were 56.3% [95% confidence interval (95% CI), 51.8-60.6%] and 42.9% (95% CI, 37.3-48.4%) at 5 and 8 years after cystectomy, respectively. Actuarial cancer-specific survival estimates were 87.3% (62.9-71.3%) and 58.7% (52.7-64.2%) at 5 and 8 years, respectively. The accuracy of a nomogram for prediction of all-cause survival (0.732) that included patient age, pT, pN, LVI, NACH, ACH, and AXRT was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.615). Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.663). Conclusions: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.

Original languageEnglish (US)
Pages (from-to)6663-6676
Number of pages14
JournalClinical Cancer Research
Volume12
Issue number22
DOIs
StatePublished - Nov 15 2006

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Nomograms
Cystectomy
Survival
Neoplasm Staging
Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Drug Therapy
Confidence Intervals
Transitional Cell Carcinoma
Carcinoma in Situ
Lymph Node Excision
Counseling
Neoplasms
Urinary Bladder
Radiotherapy
Lymph Nodes
Regression Analysis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Shariat, S. F., Karakiewicz, P. I., Palapattu, G. S., Amiel, G. E., Lotan, Y., Rogers, C. G., ... Lerner, S. P. (2006). Nomograms provide improved accuracy for predicting survival after radical cystectomy. Clinical Cancer Research, 12(22), 6663-6676. https://doi.org/10.1158/1078-0432.CCR-06-0372

Nomograms provide improved accuracy for predicting survival after radical cystectomy. / Shariat, Shahrokh F.; Karakiewicz, Pierre I.; Palapattu, Ganesh S.; Amiel, Gilad E.; Lotan, Yair; Rogers, Craig G.; Vazina, Amnon; Bastian, Patrick J.; Gupta, Amit; Sagalowsky, Arthur I.; Schoenberg, Mark; Lerner, Seth P.

In: Clinical Cancer Research, Vol. 12, No. 22, 15.11.2006, p. 6663-6676.

Research output: Contribution to journalArticle

Shariat, SF, Karakiewicz, PI, Palapattu, GS, Amiel, GE, Lotan, Y, Rogers, CG, Vazina, A, Bastian, PJ, Gupta, A, Sagalowsky, AI, Schoenberg, M & Lerner, SP 2006, 'Nomograms provide improved accuracy for predicting survival after radical cystectomy', Clinical Cancer Research, vol. 12, no. 22, pp. 6663-6676. https://doi.org/10.1158/1078-0432.CCR-06-0372
Shariat SF, Karakiewicz PI, Palapattu GS, Amiel GE, Lotan Y, Rogers CG et al. Nomograms provide improved accuracy for predicting survival after radical cystectomy. Clinical Cancer Research. 2006 Nov 15;12(22):6663-6676. https://doi.org/10.1158/1078-0432.CCR-06-0372
Shariat, Shahrokh F. ; Karakiewicz, Pierre I. ; Palapattu, Ganesh S. ; Amiel, Gilad E. ; Lotan, Yair ; Rogers, Craig G. ; Vazina, Amnon ; Bastian, Patrick J. ; Gupta, Amit ; Sagalowsky, Arthur I. ; Schoenberg, Mark ; Lerner, Seth P. / Nomograms provide improved accuracy for predicting survival after radical cystectomy. In: Clinical Cancer Research. 2006 ; Vol. 12, No. 22. pp. 6663-6676.
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abstract = "Aims: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer - specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging. Methods: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma. Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT). Two hundred bootstrap resamples were used to reduce overfit bias and for internal validation. Results: During a mean follow-up of 36.4 months, 290 of 731 (39.7{\%}) patients died; 106 of 290 patients (67.6{\%}) died of bladder cancer. Actuarial all-cause survival estimates were 56.3{\%} [95{\%} confidence interval (95{\%} CI), 51.8-60.6{\%}] and 42.9{\%} (95{\%} CI, 37.3-48.4{\%}) at 5 and 8 years after cystectomy, respectively. Actuarial cancer-specific survival estimates were 87.3{\%} (62.9-71.3{\%}) and 58.7{\%} (52.7-64.2{\%}) at 5 and 8 years, respectively. The accuracy of a nomogram for prediction of all-cause survival (0.732) that included patient age, pT, pN, LVI, NACH, ACH, and AXRT was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.615). Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.663). Conclusions: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.",
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AU - Shariat, Shahrokh F.

AU - Karakiewicz, Pierre I.

AU - Palapattu, Ganesh S.

AU - Amiel, Gilad E.

AU - Lotan, Yair

AU - Rogers, Craig G.

AU - Vazina, Amnon

AU - Bastian, Patrick J.

AU - Gupta, Amit

AU - Sagalowsky, Arthur I.

AU - Schoenberg, Mark

AU - Lerner, Seth P.

PY - 2006/11/15

Y1 - 2006/11/15

N2 - Aims: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer - specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging. Methods: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma. Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT). Two hundred bootstrap resamples were used to reduce overfit bias and for internal validation. Results: During a mean follow-up of 36.4 months, 290 of 731 (39.7%) patients died; 106 of 290 patients (67.6%) died of bladder cancer. Actuarial all-cause survival estimates were 56.3% [95% confidence interval (95% CI), 51.8-60.6%] and 42.9% (95% CI, 37.3-48.4%) at 5 and 8 years after cystectomy, respectively. Actuarial cancer-specific survival estimates were 87.3% (62.9-71.3%) and 58.7% (52.7-64.2%) at 5 and 8 years, respectively. The accuracy of a nomogram for prediction of all-cause survival (0.732) that included patient age, pT, pN, LVI, NACH, ACH, and AXRT was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.615). Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.663). Conclusions: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.

AB - Aims: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer - specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging. Methods: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma. Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT). Two hundred bootstrap resamples were used to reduce overfit bias and for internal validation. Results: During a mean follow-up of 36.4 months, 290 of 731 (39.7%) patients died; 106 of 290 patients (67.6%) died of bladder cancer. Actuarial all-cause survival estimates were 56.3% [95% confidence interval (95% CI), 51.8-60.6%] and 42.9% (95% CI, 37.3-48.4%) at 5 and 8 years after cystectomy, respectively. Actuarial cancer-specific survival estimates were 87.3% (62.9-71.3%) and 58.7% (52.7-64.2%) at 5 and 8 years, respectively. The accuracy of a nomogram for prediction of all-cause survival (0.732) that included patient age, pT, pN, LVI, NACH, ACH, and AXRT was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.615). Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P = 0.001) to that of AJCC staging - based risk grouping (0.663). Conclusions: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.

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