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Inicio Actas Urológicas Españolas (English Edition) Mortality prediction model for patients with bladder urothelial tumor after radi...
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Vol. 44. Issue 4.
Pages 215-223 (May 2020)
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Vol. 44. Issue 4.
Pages 215-223 (May 2020)
Original article
DOI: 10.1016/j.acuroe.2019.08.010
Mortality prediction model for patients with bladder urothelial tumor after radical cystectomy
Modelo predictivo de mortalidad en pacientes con tumor urotelial de vejiga tras cistectomía radical
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G. del Pozo Jiméneza,
Corresponding author
gemadpj@hotmail.com

Corresponding author.
, F. Herranz Amob, D. Subirá Ríosb, E. Rodríguez Fernándezb, G. Bueno Chomónb, M. Moralejo Gárateb, R. Durán Merinob, G. Escribano Patiñob, J. Carballido Rodrígueza, C. Hernández Fernándezb
a Servicio de Urología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Figures (2)
Tables (5)
Table 1. Patient characteristics.
Table 2. Univariate analysis of the variables related to the CSM at 1, 3 and 5 years after radical cystectomy.
Table 3. Multivariate analysis of the variables related to CSM in the 1st, 3rd and 5th year after RC. Comparison of the three predictive models (pT and pN stage).
Table 4. Comparison of the three predictive models (pT, pN, calibration and discrimination).
Table 5. Postoperative tools for predicting recurrence and survival after radical cystectomy.
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Abstract
Objective

Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC.

Material and methods

Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986–2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC.

Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan–Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer–Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve).

Results

BC was the cause of death in 225 patients (45%); 1, 3 and 5-year CSM were 17%, 39.2% and 46.3%, respectively.

The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65–77%, p=.000) for the 1st year, 73.9% (CI95% 69.2–78.6%, p=.000) for the third and 73.2% (CI% 68.5–77.9%, p=.000) for the 5th year.

Conclusions

The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8%, 73.9% and 73.2%, respectively.

Keywords:
Bladder cancer
Cystectomy
Prognostic factors
Global mortality
Cancer specific mortality
Prediction model
Resumen
Objetivo

Elaborar un modelo predictivo de mortalidad cáncer específica (MCE) a 1, 3, y 5 años basándonos en variables clínicas precirugía y patológicas poscirugía en pacientes con tumor urotelial vesical tratados con cistectomía radical.

Material y métodos

Análisis retrospectivo de 517 pacientes diagnosticados de tumor urotelial vesical y tratados con cistectomía radical (1986 y 2009). Se recogieron variables demográficas, clínicas, quirúrgicas y patológicas, así como complicaciones acontecidas y evolución tras cistectomía radical.

Análisis comparativo con test de Chi cuadrado y ANOVA. Cálculo de supervivencia con método de Kaplan-Meier y test de log-rank. Análisis univariante y multivariante mediante regresión logística para identificar las variables predictoras independientes de MCE. Se calculó la probabilidad individual de MCE a 1, 3 y 5 años según la ecuación general (función logística). La calibración se obtuvo mediante método de.

Hosmer-Lemeshow y la discriminación con elaboración de una curva ROC (área bajo la misma).

Resultados

El tumor urotelial vesical fue la causa de muerte en 225 pacientes (45%). Se obtuvo una MCE el 1.°, 3.° y 5.° años del 17%, 39,2% y 46,3% respectivamente.

El estadio pT y pN se identificaron como variables pronósticas independientes de MCE al 1.°, 3.° y 5.° años. Se construyeron 3 modelos predictivos. La capacidad predictiva fue del 70,8% (IC95% 65-77%, p=0,000) para el 1.° año, del 73,9% (IC95% 69,2-78,6%, p=0,000) para el 3.° año y del 73,2% (IC95% 68,5-77,9%, p=0,000) para el 5.° año.

Conclusiones

El modelo predictivo permite estimar el riesgo de MCE a los 1, 3 y 5 años con fiabilidad del 70,8, 73,9 y 73,2% respectivamente.

Palabras clave:
Tumor vesical
Cistectomía
Factores pronósticos
Mortalidad global
Mortalidad cáncer específica
Modelo predictivo

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