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A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following

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This study developed a nomogram to predict pelvic lymph node metastases (ypN+) in muscle-invasive bladder cancer patients after neoadjuvant chemotherapy (NAC). The tool identifies high-risk patients with poorer overall survival (OS), aiding treatment decisions.

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Area of Science:

  • Urothelial Carcinoma Research
  • Oncology Prognostics
  • Bladder Cancer Treatment

Background:

  • Pelvic lymph node metastases (ypN+) after neoadjuvant chemotherapy (NAC) indicates poor prognosis in nonmetastatic muscle-invasive bladder cancer (nmMIBC).
  • Accurate prediction of ypN+ is crucial for treatment stratification and improving patient outcomes.

Purpose of the Study:

  • To develop a predictive nomogram for ypN+ in patients with clinically node-negative (cN0) nmMIBC receiving NAC.
  • To assess the association between predicted ypN+ risk and overall survival (OS), considering competing risks.

Main Methods:

  • Utilized the National Cancer Database (2004-2020) for patients with cT2-4N0M0 urothelial carcinoma treated with NAC and surgery.
  • Developed a nomogram using logistic regression, incorporating variables like age, time to NAC, histology, and clinical T-stage.
  • Defined high- and low-risk groups based on 95% sensitivity for ypN+ and analyzed OS using Fine-Gray models.

Main Results:

  • The nomogram identified significant predictors of ypN+, including time from diagnosis to NAC and clinical T-stage.
  • High-risk patients identified by the nomogram had a significantly higher rate of ypN+ (22.8% vs. 8.0%) and worse median OS (36.1 vs. 74.0 months).
  • High-risk status correlated with increased 30-day and 90-day surgical mortality risks.

Conclusions:

  • The developed nomogram is the first tool to predict ypN+ in high-grade nmMIBC patients post-NAC.
  • This tool can identify patients with poorer OS and may guide selection for alternative neoadjuvant therapies.
  • Facilitates future research and personalized treatment strategies for bladder cancer.