J Cancer 2018; 9(7):1152-1164. doi:10.7150/jca.23344 This issue

Research Paper

Nomograms to Predict Individual Prognosis of Patients with Primary Small Cell Carcinoma of the Bladder

Fan Dong1, Yifan Shen1, Fengbin Gao2, Xiao Shi3, Tianyuan Xu2, Xianjin Wang1, Xiaohua Zhang1, Shan Zhong1, Minguang Zhang1, Shanwen Chen1, Zhoujun Shen1✉

1. Department of Urology, Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
2. Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Dong F, Shen Y, Gao F, Shi X, Xu T, Wang X, Zhang X, Zhong S, Zhang M, Chen S, Shen Z. Nomograms to Predict Individual Prognosis of Patients with Primary Small Cell Carcinoma of the Bladder. J Cancer 2018; 9(7):1152-1164. doi:10.7150/jca.23344. Available from https://www.jcancer.org/v09p1152.htm

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Objectives: To develop reliable nomograms to estimate individualized overall survival (OS) and cancer specific survival (CSS) for patients with primary small cell carcinoma of the bladder (SCCB) and compare the predictive value with the AJCC stages.

Patients and Methods: 582 eligible SCCB patients identified in the Surveillance, Epidemiology, and End Results (SEER) dataset were randomly divided into training (n=482) and validation (n=100) cohorts. Akaike information criterion was used to select the clinically important variables in multivariate Cox models when establishing nomograms. The performance of nomograms was bootstrapped validated internally and externally using the concordance index (C-index) with 95% confidence interval (95% CI) and calibration curves and was compared with that of the AJCC stages using C-index, Kaplan-Meier curves and decision curve analysis (DCA).

Results: Two nomograms shared common indicators including age, tumor size, T stage, lymph node ratio, metastases, chemotherapy, radiation and radical cystectomy, while marriage and gender were only incorporated in the OS nomogram. The C-indices of nomograms for OS and CSS were 0.736 (95%CI 0.711-0.761) and 0.731(95%CI 0.704-0.758), respectively, indicating considerable predictive accuracy. Calibration curves showed consistency between the nomograms and the actual observation. The results remained reproducible when nomograms were applied to the validation cohort. Additionally, comparisons between C-indices, Kaplan-Meier curves and DCA proved that the nomograms obtained obvious superiority over the AJCC stages with wide practical threshold probabilities.

Conclusions: We proposed the first two nomograms for individualized prediction of OS and CSS in SCCB patients with satisfactory predictive accuracy, good robustness and wide applicability.

Keywords: small cell carcinoma of the bladder, nomogram, overall survival, cancer specific survival, decision curve analysis