Development and validation of a prognostic nomogram for predicting cancer-specific survival after radical cystectomy in patients with bladder cancer:A population-based study.

Purpose: To establish a prognostic model to estimate the cancer-specific survival (CSS) for urothelial carcinoma of bladder (UCB) patients after radical cystectomy (RC).

Methods: A total of 8650 candidates (2004-2011) obtained from the Surveillance, Epidemiology, and End Results (SEER) database were randomly split into development cohort (n = 4323) and validation cohort (n = 4327). We performed Cox regression analysis to identify prognostic factors and Kaplan-Meier analysis to assess survival outcome. A nomogram predicting CSS was constructed. Its performance was validated by calibration curves, the receiver operating characteristic (ROC) curves, concordance index (C-index), decision curve analysis (DCA), the net reclassification improvement (NRI), and the integrated discrimination improvement (IDI).

Results: The nomogram incorporated marital status, T stage, N stage, tumor size, and chemotherapy. In validation cohort, C-index of the nomogram was 0.707. AUC of the nomogram and AJCC stage were 0.767 versus 0.674. Calibration plots for 3- and 5-year CSS displayed good concordance. DCA curves of the nomogram exhibited larger benefits than the AJCC stage. The NRI and IDI indicated the nomogram outperformed AJCC stage.

Conclusions: We have established a prognostic nomogram with improved discriminative ability and clinical benefits for UCB patients after RC. The nomogram alongside an easy access web tool may assist clinicians in optimizing the postoperative management.