A Nomogram Model to Predict Recurrence of Non-Muscle Invasive Bladder Urothelial Carcinoma After Resection Based on Clinical Parameters and Immunohistochemical Markers

Abstract

Objective

This study aims to establish a nomogram model by combining traditional clinical parameters with immunohistochemical markers to predict the recurrence of non-muscle invasive bladder urothelial carcinoma (NMIBUC) after resection.

Methods

In total, 504 patients were included in this study. Of these patients, 353 underwent transurethral resection of bladder tumor (TURBT) in the Yongchuan Hospital of Chongqing Medical University and were identified as a training cohort. Univariate and multivariate Cox regression analyses were used to determine the risk factors associated with recurrence in the training cohort and to establish a nomogram model. A total of 151 patients who were hospitalized in the Second Affiliated Hospital of Chongqing Medical University (validation cohort) were used for further validation. The calibration curve was generated for internal and external model validation. The clinical practicability of this model was further verified by comparing the consistency index (C-index) among various models.

Results

The mean follow-up time of the training cohort was 45.6 months (range 4–90). In total, 146 patients relapsed in training cohort. After univariate analysis, multivariate analysis further confirmed tumor grade (p=.034), immediate postoperative instillation therapy (p=.025), Ki67 (p=.047), P53 (p=.038) and CK20 (p=.049) as independent risk factors for recurrence, and these factors were included in the nomogram model. The model more accurately predicted recurrence compared with other models based on the highest C-index of 0.82 (95% CI, 0.78–0.86) in the training cohort and 0.80 (95% CI, 0.77–0.83) in the validation cohort.

Conclusions

This proposed nomogram model based on traditional clinical parameters and immunohistochemical markers can more accurately predict postoperative recurrence in patients with NMIBUC.

Keywords:

• non-muscle invasive bladder urothelial carcinoma
• traditional clinical parameters
• immunohistochemical markers
• nomogram model
• recurrence
• prognosis

View addendum:

Combining Clinical Parameters and Immunohistochemical Markers Might Strengthen Prediction of Recurrence of Non-Muscle Invasive Bladder Cancer

Acknowledgments

Thanks the Pathology Experimental Center of the Yongchuan Hospital of Chongqing Medical University and the Second Affiliated Hospital of Chongqing Medical University for providing technological assistance.

Ethical review

This retrospective study was approved by the Ethics Committee of Chongqing Medical University. All the procedures in this study complied with the principles of the Declaration of Helsinki.

Disclosure statement

The authors declare that there are no potential conflicts of interest.

1. Zhao Tao: The conception and design of the study, final approval of the version to be submitted.

2. Pi Jiangchuan: The conception and design of the study, analysis and interpretation of data, drafting the article.

3. Xiong Yongjiang, Liu Chuan, Liao Juan, Liu Jiaji, Li Chuan and Fu Wenyu: Acquisition of data.

Funding

This work was supported by the Science and Education Commission of Yongchuan District, Chongqing [grant numbers YJLC202032].

Synopsis

We have confirmed that the nomogram model based on traditional clinical parameters and immunohistochemical markers can more accurately predict postoperative recurrence in patients with NMIBUC.

Availability of data and material

The data and material can be obtained on request from the corresponding author, and not publicly available due to privacy or ethical restrictions.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

The participant has consented to the submission of the article report to the journal.