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Preoperative inflammation-based immune prognostic nomogram in bladder cancer: a multicenter study.

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Summary

This study developed a new tool to predict bladder cancer survival after surgery by combining blood test results with tumor characteristics. The inflammation-based nomogram offers a non-invasive way to personalize patient care.

Keywords:
NLRbladder cancerimmune microenvironmentoverall survivalprognostic nomogramradical cystectomysystemic inflammationtumor inflammation

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Area of Science:

  • Oncology
  • Inflammation Research
  • Biostatistics

Background:

  • Systemic inflammation is key in bladder cancer (BCa) progression and prognosis.
  • Preoperative inflammation indices offer prognostic insights but lack integration with pathology.
  • A validated clinical tool for predicting survival after radical cystectomy (RC) is needed.

Purpose of the Study:

  • To develop and validate a prognostic nomogram integrating preoperative inflammation indices and histopathological factors for bladder cancer patients undergoing RC.
  • To improve individualized survival prediction and guide treatment decisions.

Main Methods:

  • Retrospective analysis of 1,387 BCa patients undergoing RC.
  • Extraction of preoperative inflammatory indices (NLR, PLR, SII, SIRI) and clinicopathological variables (AJCC stage, PNI, LVI).
  • Development and validation of a nomogram using LASSO regression, Cox regression, C-index, ROC curves, calibration plots, and DCA.

Main Results:

  • A nomogram incorporating NLR, PLR, AJCC stage, PNI, and LVI was developed.
  • The model showed strong discrimination (C-indices 0.78 training, 0.72 validation) and predictive accuracy (AUC > 0.75 at 1, 3, 5 years).
  • Excellent calibration and clinical utility were confirmed by DCA.

Conclusions:

  • A validated, non-invasive, and cost-effective prognostic nomogram for BCa patients undergoing RC was created.
  • The nomogram effectively predicts overall survival by combining hematologic and pathologic features.
  • This tool aids in preoperative counseling, surveillance, and adjuvant therapy decisions for personalized bladder cancer management.