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

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.