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External Validation of Models for Prediction of Lymph Node Metastasis in Urothelial Carcinoma of the Bladder

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  • Ja Hyeon Ku
  • Myong Kim
  • Seok-Soo Byun
  • Hyeon Jeong
  • Cheol Kwak
  • Hyeon Hoe Kim
  • Sang Eun Lee

Abstract

Purpose: To externally validate models to predict LN metastsis; Karakiewicz nomogram, clinical nodal staging score (cNSS), and pathologic nodal staging score (pNSS) using a different cohort Materials and Methods: Clinicopathologic data from 500 patients who underwent radical cystectomy and pelvic lymphadenectomy were analyzed. The overall predictive values of models were compared with the criteria of overall performance, discrimination, calibration, and clinical usefulness. Results: Presence of pN+ stages was recorded in 117 patients (23.4%). Agreement between clinical and pathologic stage was noted in 174 (34.8%). Based on Nagelkerke’s peudo-R2 and brier score, pNSS demonstrated best overall performance. Area under the receiver operating characteristics curve, showed that pNSS had the best discriminatory ability. In all models, calibration was on average correct (calibration-in-the-large coefficient = zero). On decision curve analysis, pNSS performed better than other models across a wide range of threshold probabilities. Conclusions: When compared to pNSS, current precystectomy models such as the Karakiewicz nomogram and cNSS cannot predict the probability of LN metastases accurately. The findings suggest that the application of pNSS to Asian patients is feasible.

Suggested Citation

  • Ja Hyeon Ku & Myong Kim & Seok-Soo Byun & Hyeon Jeong & Cheol Kwak & Hyeon Hoe Kim & Sang Eun Lee, 2015. "External Validation of Models for Prediction of Lymph Node Metastasis in Urothelial Carcinoma of the Bladder," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-10, October.
    • Handle: RePEc:plo:pone00:0120552
    DOI: 10.1371/journal.pone.0120552
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    References listed on IDEAS

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    1. Andrew J. Vickers & Elena B. Elkin, 2006. "Decision Curve Analysis: A Novel Method for Evaluating Prediction Models," Medical Decision Making, , vol. 26(6), pages 565-574, November.
    2. Michael E. Miller & Carl D. Langefeld & William M. Tierney & Siu L. Hui & Clement J. McDonald, 1993. "Validation of Probabilistic Predictions," Medical Decision Making, , vol. 13(1), pages 49-57, February.
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