Developing a Novel Prognostic Model Based on Muscle-Invasive Bladder Cancer Types: A Multicenter Retrospective Cohort...

Area of Science:

• Oncology
• Urology
• Cancer Genomics

Background:

• Muscle-invasive bladder cancer (MIBC) management requires accurate prognostic tools.
• Radical cystectomy (RC) and chemotherapy are standard treatments for MIBC.
• Existing models may not fully capture prognostic variability.

Purpose of the Study:

• To develop and validate a prognostic model for cancer-specific survival (CSS) in MIBC patients.
• To stratify patients into risk groups for tailored management.
• To explore biological differences between risk groups.

Main Methods:

• A prognostic model was developed using clinicopathologic and survival data from a North American cohort.
• The model was externally validated using European and Asian databases.
• Cox's proportional hazard regression was used to identify independent CSS predictors.
• Patients were classified as primary or progressive MIBC.
• Genomic and immune markers were analyzed in relation to risk groups.

Main Results:

• Tumor stage, lymph node stage, age, ethnicity, and MIBC type were significant CSS predictors.
• The developed nomogram demonstrated good predictive power, discrimination, and calibration.
• External validation confirmed the model's robustness across cohorts.
• High-risk patients exhibited significantly poorer CSS.
• High-risk group was associated with higher stromal scores, M0/M2 macrophages, and lower regulatory T cells.

Conclusions:

• The MIBC type-based nomogram offers accurate CSS predictions.
• This tool can enhance patient management and clinical decision-making for MIBC.
• Understanding immune microenvironment differences may inform future therapeutic strategies.