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. 2023 Feb;21(1):108-114.
doi: 10.1016/j.clgc.2022.08.011. Epub 2022 Sep 6.

Development of a Pocket Nomogram to Predict Cancer and Disease Specific Survival After Radical Cystectomy For Bladder Cancer: The CRAB Nomogram

Antonio Cicione  1 , Giuseppe Simone  2 , Riccardo Lombardo  1 , Antonio Franco  1 , Antonio Nacchia  1 , Nicola Ghezzo  1 , Filippo Zammitti  1 , Alessio Guidotti  1 , Giacomo Gallo  1 , Emilio Molinaro  3 , Costantino Leonardo  3 , Michele Gallucci  3 , Siamak Daneshmand  4 , Gus Miranda  4 , Mihir M Desai  4 , Inderbir Gill  4 , Hassan Abol-Enein  5 , Andrea Tubaro  1 , Cosimo De Nunzio  6
Affiliations

Development of a Pocket Nomogram to Predict Cancer and Disease Specific Survival After Radical Cystectomy For Bladder Cancer: The CRAB Nomogram

Antonio Cicione et al. Clin Genitourin Cancer. 2023 Feb.

Abstract

Objectives: To develop an easy tool to predict cancer specific (CSS) and disease-free survival (DFS) in patients with bladder cancer treated with radical cystectomy.

Methods: Data from a consecutive series of 2395 patients with primitive or progression to muscle invasive bladder cancer (MIBC) undergone to radical cystectomy and lymph nodes dissection in 5 centers were evaluated. Using Cox proportional hazards analyses, the Cancer of the bladder risk assessment (CRAB) nomogram was generated. Accuracy of the nomogram was evaluated by Harrell's C test. Internal validation of the model was performed using 200 bootstraps.

Results: Median age was 66 (IQR 58/73) years; 612/2395 (26%) patients presented an advanced pathological stage (≥pT3a); 478/2395 (20%) presented positive lymph nodes. Overall, 729/2395 (30%) presented local or distant recurrence with a median DFS of 42 (IQR 14/89) months. Overall, 642/2395 (27%) died of bladder cancer with a median follow up of 48 (IQR 22/92) months. On univariate Cox proportional hazards analyses, age, stage, and lymph nodes density were a significant predictor of 3 and5 years CSS and DFS. Accuracy of the CRAB nomogram was 0.73 and 0.71 respectively.

Conclusion: CRAB nomogram can be a practical and easily applicable tool that may help urologists to classify the long-term CSS and DFS of patients treated with radical cystectomy and to predict the oncological outcome.

Keywords: Bladder Cancer; Cystectomy; Nomogram; Survival.

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