Use of nomograms as predictive tools in bladder cancer

Risk factors and nomogram for newly diagnosis of bone metastasis in bladder cancer: A SEER-based study

Bladder cancer (BC) is the second most common urogenital malignant tumor. Bone metastasis (BM) is not common in BC patients, and there are only few studies on it. However, it was found in a clinical study that BM was related to the occurrence of bone complications and the decrease in survival rate. Early diagnosis of BC with BM is important for timely intervention and prevention of pathological fracture, which is of great significance for improving the quality of life of BC patients. This study aimed to identify the risk factors of BM and establish a predictive nomogram for the early diagnosis of BM in BC.The medical records of the newly diagnosed BC patients were extracted from the database of Surveillance, Epidemiology, and End Results (SEER) during 2010 to 2016. The risk factors of BC with BM were evaluated using multivariate logistic regression analysis. Then a nomogram was established to predict the risk of BC with BM.This study included 35,506 patients identified in the SEER database as diagnosed with BC, 796 of whom had BM. Grade, T stage, N stage, liver metastasis, race, brain metastasis, lung metastasis, histologic type, primary site, and age were risk predictors of BC with BM. Using Harrell's concordance index, calibration curve, and decision curve analyses, we found that the nomogram for predicting the risk of BC metastasis performed well internally.The nomogram developed in this study is expected to become an accurate and personalized tool for predicting risks of BC with BM in patients. It may be of great significance for clinicians to formulate more reasonable and effective treatment strategies. As the first study, we established a predictive nomogram for BC with BM based on the retrospective analysis of data of BC patients from the SEER database.

The clinical use of statistical permutation test methodology: a tool for identifying predictive variables of outcome

OBJECTIVES

To identify the predictive variables affecting the outcome after radical surgery for bladder cancer by a newer statistical methodology, i.e. nonparametric combination (NPC).

METHODS

A multicenter study enrolled 1,312 patients who had undergone radical cystectomy for bladder cancer in 11 Italian oncological centers from January 1982 to December 2002. A statistical analysis of their medical history and diagnostic, pathological and postoperative variables was performed using a NPC test. The patients were included in a comprehensive database with medical history and clinical and pathological data. Five-year survival was used as the dependent variable, and p values were corrected for multiplicity using a closed testing procedure. The newer nonparametric approach was used to evaluate the prognostic importance of the variables. All of the analyses were performed using routines developed in MATLAB© and the significance level was set at α = 0.05.

RESULTS

A significant prognostic predictive value (p < 0.01) for tumor clinical staging, hydronephrosis, tumor pathological staging, grading, presence of concomitant carcinoma in situ, regional lymph node involvement, corpora cavernosa invasion, microvascular invasion, lymphatic invasion and prostatic stroma involvement was found.

CONCLUSIONS

The NPC test could handle any type of variable (categorical and quantitative) and take into account the multivariate relation among variables. This newer methodology offers a significant contribution in biomedical studies with several endpoints and is recommended in presence of non-normal data and missing values, as well as solving high-dimensional data and problems relating to small sample sizes.

Impact of NK Cell Count on Bladder Cancer Recurrence

Purpose

The aim of the present study was to evaluate the prognostic value of the local NK cell count in patients with recurrent non-muscle-invasive bladder cancer.

Methods

The archival paraffin-embedded primary tumor specimens were derived from retrospectively-selected patients, who were treated between 1996 and 2001 for bladder cancer. The study group consisted of 46 patients who developed recurrent disease during their first two post-operative years. The control group consisted of 27 patients who did not develop recurrent disease during their first two post-operative years. Specimens were assessed immunohistochemically with standard “ABC” technique. The frequency of NK cells was expressed as total number, estimated for each tumor by counting the positive NK cells in 10 high-power representative fields. Statistical analysis was done using Kruskal-Wallis test.

Results

Patients with recurrent non-muscle invasive bladder cancer in general have significantly higher values of stromal NK cell count than the control group. Patients with single tumor and smaller tumors show a statistically significant difference in NK cell count between study and control group. There also exists a statistically significant difference in stromal NK cell count in patients with clinical stage Ta tumor.

Conclusions

Our results confirm an association of the bladder wall NK cell count in bladder cancer patients with the natural history of disease. Further well-performed, reproducible, large, prospective investigation stratified by clinical parameters, such as tumor number and diameter, is needed to display the true value of this marker in the clinical work-up of bladder cancer patients.

Incidental Sonographic Detection of Non–Muscle-Invasive Papillary Urothelial Carcinoma in a Low-Risk Patient

This case presentation describes the early diagnosis of an invasive urinary bladder cancer in a woman in her late 60s with no history of cancer, hematuria, dysuria, smoking, or hormone replacement therapy. This was confirmed on histopathology after tumor resection. The case report demonstrates the importance of including scanning the urinary bladder in all pelvic sonography examinations, even in the low-risk population. The following study also discusses the prevalence, etiology, diagnostic tools, prognosis, and treatment of bladder cancer. Different types of bladder tumors, staging, and grading criteria are also described.

A multiplexed, particle-based flow cytometric assay identified plasma matrix metalloproteinase-7 to be associated with cancer-related death among patients with bladder cancer

BACKGROUND

The current study was conducted to demonstrate the utility of a multiplexed, particle-based flow cytometric assay for the simultaneous analysis of a panel of matrix metalloproteinases (MMPs) using small volumes of plasma samples from patients with bladder cancer. In addition, the authors attempted to test the hypothesis that plasma levels of MMPs are associated with time to cancer-related death.

METHODS

Plasma MMP concentrations (MMP-1, -2, -3, -7, -8, -9, and -12) in 135 patients presenting with high-grade≥T1 bladder cancer were measured. Data regarding clinical and pathologic features was ascertained in a retrospective fashion.

RESULTS

The median duration of follow-up was 30.4 months. At the time of analysis, 61 patients had died, including 45 (33.3%) who died of bladder cancer. Plasma MMP-12 was not measurable. For all other MMPs, the intra-assay coefficient of variation varied from 6.12% to 9.82%. MMP-1, -2, -3, -8, and -9 were not found to be significantly associated with time to cancer-related death. Plasma MMP-7 levels were significantly associated with time to cancer-related death after adjustment for competing clinical and pathologic features (hazard ratio [HR], 2.2; 95% confidence interval [95% CI], 1.1-4.5 [P=.022]). The 5-year median cancer-specific survival rates for those patients with MMP-7 levels above and below the median value (300 pg/mL) were 73.6% (95% CI, 60.0-83.2%) and 48.0% (95% CI, 32.5-61.9%), respectively (P=.01).

CONCLUSIONS

Multiplexed, particle-based flow cytometric assay allows for the high-throughput measurement of multiple plasma or serum proteins simultaneously. By using this new technology in a cohort of patients with bladder cancer, plasma levels of MMP-7 were identified as being significantly associated with time to cancer-related death.

The value of bladder-conserving strategies in muscle-invasive bladder carcinoma compared with radical surgery

PURPOSE OF REVIEW

Patients with muscle-invasive bladder cancer will practically all develop progression, often associated with severe side effects including pain, dysuria or macrohematuria. Recent reports demonstrate multimodality bladder-sparing approaches as primary treatment for muscle-invasive bladder cancer.

RECENT FINDINGS

Bladder-conserving strategies include thorough transurethral resection of the bladder tumor, external beam radiation therapy and chemotherapy. It has been shown that survival rates are similar to those of radical cystectomy series; additionally, a substantial number of patients survive with an intact bladder. The high costs, close cooperation between clinical specialists and a highly compliant patient need to be taken into consideration, however.

SUMMARY

Nowadays, the good long-term results after radical cystectomy with the creation of an orthotopic neobladder make the substantial advantage of a bladder-preserving strategy questionable when the patient's quality of life is addressed. Multimodality bladder-conserving strategies are a therapeutic option for selected patients; however, radical cystectomy remains the gold standard of treatment.