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Multifactorial, site-specific recurrence models after radical cystectomy for urothelial carcinoma: external validation in a cohort of Korean patients.

Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH - PLoS ONE (2014)

Bottom Line: Kaplan-Meier curves demonstrated that models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366).Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy, but not the model for upper urinary tract recurrence.Abdomen/pelvis, thoracic region, and bone models demonstrate moderate discrimination, adequate calibration, and meaningful net benefit gains, whereas upper urinary tract model does not seem applicable to patients from Asia because it has suboptimal accuracy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The aim of this study was to evaluate the accuracy of site-specific recurrence models after radical cystectomy in the Korean population.

Materials and methods: We conducted a review of an electronic medical record of 572 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. Primary end point was the site-specific recurrence after radical cystectomy.

Results: The median follow-up in the validation cohort was 42.3 months (interquartile range: 23.0-89.3 months). During the follow-up period, there were 165 patients (28.8%), 85 (14.9%), 31 (5.4%), and 78 (13.6%) who recurred in abdomen/pelvis, thoracic region, upper urinary tract, and bone, respectively. The c-indices of abdomen/pelvis, thoracic region, upper urinary tract, and bone models 3 years after radical cystectomy were 0.69 (95% confidence interval [CI], 0.65-0.73), 0.69 (95% CI, 0.64-0.75), 0.61 (95% CI, 0.52-0.69), and 0.65 (95% CI, 0.59-0.71), respectively. Kaplan-Meier curves demonstrated that models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366). Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy, but not the model for upper urinary tract recurrence.

Conclusions: Abdomen/pelvis, thoracic region, and bone models demonstrate moderate discrimination, adequate calibration, and meaningful net benefit gains, whereas upper urinary tract model does not seem applicable to patients from Asia because it has suboptimal accuracy.

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Related in: MedlinePlus

Decision curve analysis.Three-year site-specific recurrence-free survival of abdomen/pelvis model (A), thoracic region model (B), upper urinary tract model (C), and bone model (D). Five-year overall survival (E); model 1– abdomen/pelvis mode; model 2– thoracic region model; model 3– upper urinary tract model; and model 4– bone model. In decision curve analysis, the y-axis measures net benefit, calculated by summing the benefits (true positives) and subtracting the harms (false positives).
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pone-0100491-g002: Decision curve analysis.Three-year site-specific recurrence-free survival of abdomen/pelvis model (A), thoracic region model (B), upper urinary tract model (C), and bone model (D). Five-year overall survival (E); model 1– abdomen/pelvis mode; model 2– thoracic region model; model 3– upper urinary tract model; and model 4– bone model. In decision curve analysis, the y-axis measures net benefit, calculated by summing the benefits (true positives) and subtracting the harms (false positives).

Mentions: In Kaplan-Meier curves for patients stratified into groups from each model, patients were clustered into three or five groups according to their model-predicted recurrence. As depicted, models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366) (Fig. 1C). Figure 2 presents the results of the decision curve analysis of site-specific recurrence at 3 years (2A-2D) and overall survival at 5 years (2E) for each model. Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy (2A, 2B, and 2D), but not the model for upper urinary tract recurrence (2C). Also, the upper urinary tract model had a lesser net benefit for prediction of overall survival compared with other models (2E).


Multifactorial, site-specific recurrence models after radical cystectomy for urothelial carcinoma: external validation in a cohort of Korean patients.

Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH - PLoS ONE (2014)

Decision curve analysis.Three-year site-specific recurrence-free survival of abdomen/pelvis model (A), thoracic region model (B), upper urinary tract model (C), and bone model (D). Five-year overall survival (E); model 1– abdomen/pelvis mode; model 2– thoracic region model; model 3– upper urinary tract model; and model 4– bone model. In decision curve analysis, the y-axis measures net benefit, calculated by summing the benefits (true positives) and subtracting the harms (false positives).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061079&req=5

pone-0100491-g002: Decision curve analysis.Three-year site-specific recurrence-free survival of abdomen/pelvis model (A), thoracic region model (B), upper urinary tract model (C), and bone model (D). Five-year overall survival (E); model 1– abdomen/pelvis mode; model 2– thoracic region model; model 3– upper urinary tract model; and model 4– bone model. In decision curve analysis, the y-axis measures net benefit, calculated by summing the benefits (true positives) and subtracting the harms (false positives).
Mentions: In Kaplan-Meier curves for patients stratified into groups from each model, patients were clustered into three or five groups according to their model-predicted recurrence. As depicted, models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366) (Fig. 1C). Figure 2 presents the results of the decision curve analysis of site-specific recurrence at 3 years (2A-2D) and overall survival at 5 years (2E) for each model. Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy (2A, 2B, and 2D), but not the model for upper urinary tract recurrence (2C). Also, the upper urinary tract model had a lesser net benefit for prediction of overall survival compared with other models (2E).

Bottom Line: Kaplan-Meier curves demonstrated that models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366).Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy, but not the model for upper urinary tract recurrence.Abdomen/pelvis, thoracic region, and bone models demonstrate moderate discrimination, adequate calibration, and meaningful net benefit gains, whereas upper urinary tract model does not seem applicable to patients from Asia because it has suboptimal accuracy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The aim of this study was to evaluate the accuracy of site-specific recurrence models after radical cystectomy in the Korean population.

Materials and methods: We conducted a review of an electronic medical record of 572 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. Primary end point was the site-specific recurrence after radical cystectomy.

Results: The median follow-up in the validation cohort was 42.3 months (interquartile range: 23.0-89.3 months). During the follow-up period, there were 165 patients (28.8%), 85 (14.9%), 31 (5.4%), and 78 (13.6%) who recurred in abdomen/pelvis, thoracic region, upper urinary tract, and bone, respectively. The c-indices of abdomen/pelvis, thoracic region, upper urinary tract, and bone models 3 years after radical cystectomy were 0.69 (95% confidence interval [CI], 0.65-0.73), 0.69 (95% CI, 0.64-0.75), 0.61 (95% CI, 0.52-0.69), and 0.65 (95% CI, 0.59-0.71), respectively. Kaplan-Meier curves demonstrated that models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366). Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy, but not the model for upper urinary tract recurrence.

Conclusions: Abdomen/pelvis, thoracic region, and bone models demonstrate moderate discrimination, adequate calibration, and meaningful net benefit gains, whereas upper urinary tract model does not seem applicable to patients from Asia because it has suboptimal accuracy.

Show MeSH
Related in: MedlinePlus