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. 2023 Dec;12(24):21627-21638.
doi: 10.1002/cam4.6712. Epub 2023 Nov 16.

A novel nomogram based on body composition and nutritional indicators to predict the prognosis of patients with muscle-invasive bladder cancer undergoing radical cystectomy

Xin Zhong  1 , Yunzhe Pan  2 , Kang Wu  1 , Langkun Wang  1 , Peng Dou  1 , Ping Tan  1 , Peng Zhang  1 , Xiang Li  1
Affiliations

A novel nomogram based on body composition and nutritional indicators to predict the prognosis of patients with muscle-invasive bladder cancer undergoing radical cystectomy

Xin Zhong et al. Cancer Med. 2023 Dec.

Abstract

Objective: To investigate the prognostic significance of body composition and nutritional indicators in patients undergoing radical cystectomy with muscle-invasive bladder cancer (MIBC) and to develop a novel nomogram that accurately predicts overall survival (OS).

Methods: From December 2010 to December 2020, we retrospectively collected clinical and pathological data from 373 MIBC patients who underwent radical cystectomy at our hospital. Preoperative computed tomography (CT) images were used to measure the skeletal muscle index (SMI), subcutaneous adipose index (SAI), visceral adipose index (VAI), skeletal muscle density (SMD), subcutaneous adipose density (SAD), visceral adipose density (VAD), and visceral adipose to subcutaneous adipose area ratio (VSR). The clinicopathological characteristics were evaluated using LASSO regression and multivariate Cox regression, and a nomogram was constructed to predict 1-, 3-, and 5-year overall survival. The concordance index (C-index), time-dependent receiver operating characteristic curves (t-ROC), calibration curve, and decision curve analysis (DCA) were used to assess the discriminative ability, calibration, and clinical practicality of the nomogram.

Results: Multivariate analyses demonstrated that pT stage, lymph node status, LVI, SMD, and prognostic nutritional index (PNI) are independent prognostic factors for OS. Additionally, a nomogram was created. The nomogram's C-index was 0.714 (95% CI: 0.695-0.733). The area under the t-ROC curve of 1-, 3-, and 5-year survival corresponding to the model was 0.726, 0.788, and 0.785, respectively. The calibration curve demonstrated excellent agreement between the predicted and observed outcomes. The DCA revealed that patients with MIBC could benefit from the nomogram.

Conclusion: Based on body composition and nutritional indicators, we developed a novel nomogram with excellent predictive accuracy and reliability for predicting the prognosis of MIBC patients undergoing RC.

Keywords: MIBC; body composition; nomogram; nutritional indicators; prognosis.

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Conflict of interest statement

There are no competing interests disclosed by the authors.

Figures

FIGURE 1
FIGURE 1
Examples of subcutaneous fat area (blue), visceral fat area (yellow), and skeletal muscle area (red) segmentations at the third lumbar vertebra from two different patients.
FIGURE 2
FIGURE 2
ROC of body composition and AUC. AUC, area under curve; ROC, receiver operating characteristic curve; SAD, subcutaneous adipose density; SAI, subcutaneous adipose index; SMD, skeletal muscle density; SMI, skeletal muscle index; VAD, visceral adipose density; VAI, visceral adipose index; VSR, visceral adipose to subcutaneous adipose area ratio.
FIGURE 3
FIGURE 3
Variable selection using least absolute shrinkage and selection operator (LASSO) regression.
FIGURE 4
FIGURE 4
Kaplan–Meier survival curves for pT stage (A), lymph node status (B), lymphovascular invasion (C), PNI (D), and SMD (E).
FIGURE 5
FIGURE 5
Nomogram for predicting 1‐, 3‐, and 5‐year survival of MIBC patients undergoing radical cystectomy.
FIGURE 6
FIGURE 6
Time‐dependent receiver operating characteristic of the nomogram.
FIGURE 7
FIGURE 7
Calibration plot of the nomogram for predicting 1‐year OS (A), predicting 3‐year OS (B), and 5‐year OS (C).
FIGURE 8
FIGURE 8
Decision curve analysis of the nomogram for predicting 1‐ year OS (A), 3‐ year OS (B), and 5‐ year OS (C).
See this image and copyright information in PMC

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