Abstract

Background

The aim of this study is to establish new risk tables for the current clinical setting, enabling short- and long-term risk stratification for recurrence, progression, and cancer-specific death after transurethral resection in non-muscle invasive bladder cancer (NMIBC). Currently available risk tables lack input from the 2004 World Health Organization grading system and risk prediction for cancer-specific death.

Methods

This was a multi-institutional database study of 1490 patients diagnosed with NMIBC (the development cohort). A multivariate Fine and Gray subdistribution hazard model was used to assess the prognostic impact of various factors. Patients were classified into low-, intermediate-, and high-risk groups according to a sum of the weight of selected factors, and predicted cumulative rates were calculated. Internal validation was conducted using 200 bootstrap resamples to assess the optimism for the c-index and estimate a bias-corrected c-index. External validation of the developed risk table was performed on an independent dataset of 91 patients.

Results

The Japanese NIshinihon uro-onCology Extensive collaboration group (J-NICE) risk stratification table was derived from six, five, and two factors for recurrence, progression, and cancer-specific death, respectively. The internal validation bias-corrected c-index values were 0.619, 0.621, and 0.705, respectively. The application of the J-NICE table to an external dataset resulted in c-indices for recurrence, progression, and cancer-specific death of 0.527, 0.691, and 0.603, respectively.

Conclusions

We propose a novel risk stratification model that predicts outcomes of treated NMIBC and may overcome the shortcomings of existing risk models. Further external validation is required to strengthen its clinical impact.

中文翻译：

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非肌肉浸润性膀胱癌患者膀胱内复发，疾病进展和特定于癌症的死亡的新风险分层模型：J-NICE风险表。

摘要

背景

这项研究的目的是为当前的临床环境建立新的风险表，从而在非肌肉浸润性膀胱癌（NMIBC）中经尿道切除术后复发，进展和癌症特异性死亡的短期和长期风险分层成为可能。当前可用的风险表缺少2004年世界卫生组织分级系统的输入以及癌症特定死亡的风险预测。

方法

这是一项多机构数据库研究，涉及1490名被诊断患有NMIBC（发展队列）的患者。多元Fine和Gray子分布危害模型用于评估各种因素对预后的影响。根据所选因素的权重总和，将患者分为低，中和高风险组，然后计算出预测的累积率。内部验证使用200个bootstrap重采样进行，以评估c指数的乐观程度并估计偏差校正的c指数。已开发风险表的外部验证是在91位患者的独立数据集中进行的。

结果

日本NIshinihon uro-onCology广泛合作小组（J-NICE）风险分层表分别来自于复发，进展和癌症特异性死亡的六个，五个和两个因素。内部验证偏差校正的c-index值分别为0.619、0.621和0.705。将J-NICE表应用于外部数据集，导致复发，进展和特定于癌症的死亡的c指数分别为0.527、0.691和0.603。

结论

我们提出了一种新颖的风险分层模型，该模型可以预测已治疗的NMIBC的结果，并可以克服现有风险模型的缺点。需要进一步的外部验证以增强其临床效果。