External validation of existing nomograms predicting lymph node metastases in cystectomized patients
Miroslav M Stojadinovic1, Rade I Prelevic
1Deparment of Urology, Clinic of Urology and Nephrology, Clinical Centre Kragujevac, Zmaj Jovina 30, 34 000, Kragujevac, Serbia, midinac@EUnet.rs.
International Journal of Clinical Oncology
|April 12, 2014
Summary
The Green et al. nomogram for predicting lymph node involvement in bladder cancer patients showed moderate accuracy in a European validation study. It may aid clinical decisions, but further improvements are needed.
Area of Science:
- Urology
- Oncology
- Medical Statistics
Background:
- Pre-cystectomy nomograms by Karakiewicz et al. and Green et al. predict lymph node involvement.
- External validation in European intermediate-volume centers is crucial.
Purpose of the Study:
- To externally validate the Karakiewicz et al. and Green et al. nomograms.
- To assess their applicability in a European patient cohort.
Main Methods:
- Validation using a Serbian single-center cystectomy series (183 patients).
- Multivariate regression analysis of clinical parameters.
- Calculation of predictive accuracy, calibration, and clinical utility.
Main Results:
- Significant differences in risk variables compared to development datasets.
- 109 (59.6%) patients had lymph node metastases.
- Green et al. nomogram showed moderate predictive accuracy (61.2-69.1%) and provided net benefit in decision curve analysis.
Conclusions:
- The Green et al. nomogram appears applicable in Europe despite differing risk factors.
- Its use could improve clinical decision-making for bladder cancer.
- Further development of predictive models with enhanced accuracy is recommended.
