External Validation of Models for Prediction of Lymph Node Metastasis in Urothelial Carcinoma of the Bladder |
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Authors: | Ja Hyeon Ku Myong Kim Seok-Soo Byun Hyeon Jeong Cheol Kwak Hyeon Hoe Kim Sang Eun Lee |
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Affiliation: | 1. Department of Urology, Seoul National University Hospital, Seoul, Korea.; 2. Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.; 3. Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea.; Centro Nacional de Investigaciones Oncológicas (CNIO), SPAIN, |
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Abstract: | PurposeTo externally validate models to predict LN metastsis; Karakiewicz nomogram, clinical nodal staging score (cNSS), and pathologic nodal staging score (pNSS) using a different cohortMaterials and MethodsClinicopathologic data from 500 patients who underwent radical cystectomy and pelvic lymphadenectomy were analyzed. The overall predictive values of models were compared with the criteria of overall performance, discrimination, calibration, and clinical usefulness.ResultsPresence of pN+ stages was recorded in 117 patients (23.4%). Agreement between clinical and pathologic stage was noted in 174 (34.8%). Based on Nagelkerke’s peudo-R2 and brier score, pNSS demonstrated best overall performance. Area under the receiver operating characteristics curve, showed that pNSS had the best discriminatory ability. In all models, calibration was on average correct (calibration-in-the-large coefficient = zero). On decision curve analysis, pNSS performed better than other models across a wide range of threshold probabilities.ConclusionsWhen compared to pNSS, current precystectomy models such as the Karakiewicz nomogram and cNSS cannot predict the probability of LN metastases accurately. The findings suggest that the application of pNSS to Asian patients is feasible. |
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