Preoperative prognostic nutritional index and nomogram predicting recurrence-free survival in patients with primary non-muscle-invasive bladder cancer without carcinoma in situ

Figures & data

Table 1 Clinicopathological characteristics of 329 patients with NMIBC stratified by EORTC-GUCG risk group

	All patients (n=329)	Low risk (n=31)	Intermediate risk (n=189)	High risk (n=109)	p-value
Gender, n (%)
Male/female	262 (79.6)/67 (20.4)	23 (74.2)/8 (25.8)	148 (78.3)/41 (21.7)	91 (83.5)/18 (16.5)	0.413
Age (years)
Mean ± SD	62.90±12.50	58.32±12.98	61.76±12.98	66.16±10.75	0.001
Median (range)	63 (28–89)	66 (28–88)	63.5 (32–89)	67 (32–85)
History of smoking, n (%)
Yes	93 (28.3)	11 (35.5)	53 (28.0)	29 (26.6)	0.622
No	236 (71.7)	20 (64.5)	136 (72.0)	80 (73.4)
Symptoms, n (%)
Positive	259 (78.1)	23 (74.2)	140 (74.1)	96 (88.1)	0.014
Negative	70 (21.9)	8 (25.8)	49 (25.9)	13 (11.9)
Tumor focality, n (%)
Unifocal	206 (62.6)	31 (100.0)	107 (56.6)	68 (62.4)	0.272
Multifocal	123 (37.4)	0 (0.0)	82 (43.4)	41 (37.6)
Tumor size, n (%)
≤1 cm	61 (18.6)	11 (35.5)	37 (19.6)	13 (11.9)	<0.001
1–3 cm	155 (47.1)	20 (64.5)	84 (44.4)	51 (46.8)
≥3 cm	113 (34.3)	0 (0.0)	68 (36.0)	45 (41.3)
Tumor grade, n (%)
G1	55 (16.7)	31 (100.0)	24 (12.7)	0 (0.0)	<0.001
G2	189 (57.5)	0 (0.0)	165 (87.3)	0 (0.0)
G3	85 (25.8)	0 (0.0)	0 (0.0)	85 (100.0)
Pathological T stage, n (%)
pTa	247 (75.1)	31 (100.0)	189 (100.0)	27 (24.8)	<0.001
pT1	82 (24.9)	0 (0.0)	0 (0.0)	82 (75.2)

Abbreviations: NMIBC, non-muscle-invasive bladder cancer; EORTC-GUCG, European Organization for the Research and Treatment of Cancer; SD, standard deviation.

Figure 1 Kaplan–Meier survival curves for recurrence-free survival of all patients with non-muscle-invasive bladder cancer stratified by EORTC-GUCG risk scoring system.

Abbreviation: EORTC-GUCG, European Organization for the Research and Treatment of Cancer.

Table 2 Clinicopathological characteristics of 329 patients with NMIBC stratified by PNI

	PNI		p-value
	<52.57 (n=169)	≥52.57 (n=160)
Gender, n (%)
Male/female	135 (79.9)/34 (20.1)	127 (79.4)/33 (20.6)	0.909
Age (years)
Mean ± SD	64.45±12.83	61.26±11.95	0.02
Median (range)	67 (32–88)	61 (28–89)
History of smoking, n (%)
Yes	52 (30.8)	41 (25.6)	0.300
No	117 (69.2)	119 (74.4)
Symptoms, n (%)
Positive	138 (81.7)	121 (75.6)	0.182
Negative	31 (18.3)	39 (24.4)
Tumor focality, n (%)
Unifocal	101 (59.8)	105 (65.6)	0.272
Multifocal	68 (40.2)	55 (34.4)
Tumor size, n (%)
≤1 cm	30 (17.7)	31 (19.4)	0.382
1–3 cm	75 (44.4)	80 (50.0)
≥3 cm	64 (37.9)	49 (30.6)
Tumor grade, n (%)
G1	27 (16.0)	28 (17.5)	0.032
G2	88 (52.0)	101 (63.1)
G3	54 (32.0)	31 (19.4)
Pathological T stage, n (%)
pTa	120 (71.0)	127 (79.4)	0.079
pT1	49 (29.0)	33 (20.6)
Albumin (g/L)
Mean ± SD	40.82±3.30	45.07±2.92	<0.001
Median (range)	41.4 (26.3–48.2)	44.8 (37.0–54.3)
Lymphocyte (×10^9/L)
Mean ± SD	1.50±0.42	2.22±0.64	<0.001
Median (range)	1.49 (0.44–2.89)	2.16 (0.6–4.59)

Abbreviations: NMIBC, non-muscle-invasive bladder cancer; PNI, prognostic nutritional index; SD, standard deviation.

Figure 2 Kaplan–Meier survival curves for recurrence-free survival of patients with non-muscle-invasive bladder cancer stratified by PNI.

Abbreviation: PNI, prognostic nutritional index.

Figure 3 Kaplan–Meier survival curves for different EORTC-GUCG risk groups of patients with non-muscle-invasive bladder cancer stratified by PNI: (A) low risk; (B) intermediate risk; and (C) high risk.

Abbreviations: EORTC-GUCG, European Organization for the Research and Treatment of Cancer; PNI, prognostic nutritional index.

Table 3 Univariate and multivariate Cox proportional hazards regression analyses of RFS in 329 patients with NMIBC

Variable	Univariate		Multivariate
	HR (95% CI)	p-value	HR (95% CI)	p-value
Gender
Male	1 (reference)	0.827
Female	1.049 (0.685–1.606)
Age (years)
<50	1 (reference)	0.004	1.000 (reference)	0.039
≥50	2.562 (1.342–4.891)		2.007 (1.036–3.885)
History of smoking
No	1 (reference)	0.833
Yes	1.043 (0.705–1.544)
Symptoms
Positive	1 (reference)	0.238
Negative	0.758 (0.478–1.201)
Tumor focality
Unifocal	1 (reference)	0.013	1.000 (reference)	0.030
Multifocal	1.564 (1.100–2.224)		1.484 (1.039–2.119)
Tumor size (cm)
≤1	1 (reference)
1–3	1.835 (1.024–3.291)	0.041
≥3	2.477 (1.373–4.466)	0.003
Tumor grade
G1	1 (reference)		1.000 (reference)
G2	3.165 (1.455–6.885)	0.004	2.603 (1.186–5.713)	0.017
G3	6.030 (2.727–13.336)	<0.001	2.933 (1.228–7.003)	0.015
Tumor stage
pTa	1 (reference)	<0.001	1.000 (reference)	0.016
pT1	2.563 (1.784–3.682)		1.737 (1.108–2.724)
PNI
<52.57	1 (reference)	<0.001	1.000 (reference)	0.007
≥52.57	0.510 (0.354–0.733)		0.598 (0.410–0.870)

Abbreviations: RFS, recurrence-free survival; NMIBC, non-muscle-invasive bladder cancer; HR, hazard ratio; CI, confidence interval; PNI, prognostic nutritional index.

Figure 4 Nomogram for predicting RFS in patients with non-muscle-invasive bladder cancer.

Abbreviations: RFS, recurrence-free survival; PNI, prognostic nutritional index.

Figure 5 Calibration curves for internal validation of estimating RFS in patients with non-muscle-invasive bladder cancer: (A) 1-year outcome; (B) 3-year outcome; and (C) 5-year outcome.

Abbreviation: RFS, recurrence-free survival.