Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press32010.17650/1726-9776-2012-8-2-44-54DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак мочевого пузыряCREATION OF THE NOMOGRAM THAT PREDICTS PATHOLOGICAL LOCAL EXTENT OF THE BLADDER CANCER BASED ON CLINICAL VARIABLESПОСТРОЕНИЕ НОМОГРАММЫ, ПРОГНОЗИРУЮЩЕЙ ПАТОЛОГИЧЕСКУЮ СТЕПЕНЬ МЕСТНОЙ РАСПРОСТРАНЕННОСТИ РАКА МОЧЕВОГО ПУЗЫРЯ ПО КЛИНИЧЕСКИМ ДАННЫМMirylenkaL. V.МириленкоЛ. В.
Belarus
ludamirilen@gmail.comSukonkoO. G.СуконкоО. Г.
Belarus
ludamirilen@gmail.comPravorovA. V.ПраворовА. В.
Belarus
ludamirilen@gmail.comRolevichA. I.РолевичА. И.
Belarus
ludamirilen@gmail.comMavrichevA. S.МавричевА. С.
Belarus
ludamirilen@gmail.comN.N. Alexandrov National Cancer Centre of Belarus, MinskРеспубликанский НПЦ онкологии и медицинской радиологии им. Н.Н. Александрова, Минск, Республика Беларусь300620128244540608201406082014https://oncourology.abvpress.ru/oncur/article/view/320

Objective: to develop nomogram based on clinical variables, that predicts pathological local extent of the bladder cancer рТ3-рТ4 (рТ3+).

Material and methods: We used data of 511 patients with bladder cancer, that have undergone radical cystectomy between 1999 and 2008 at N.N. Alexandrov National Cancer Centre. For prediction of pT3+ on preoperative data were used mono- and multivariate logistic regression analysis. Coefficients from logistic regression equalization were used to construct nomogram. Nomogram accuracy was evaluated with concordance index (с-index) and by building the calibration plot. Internal validation by bootstrap method with 200 variants of dataset was performed.

Results: We developed nomogram, that include: clinical stage сТ, tumor grade, tumor macroscopic appearance, presence of upper tract dilatation, prostatic urethra and/or prostatic lobe(s) involvement, 3 or more bladder walls involvement, ESR and creatinine level. Bootstrapcorrected prognostic accuracy of nomogram was 81,4%, that 12,6% better than clinical stage accuracy.

Conclusion: developed nomogram can significantly improve pathologic tumor stage prediction accuracy that may be used to select patients for neoadjuvant chemotherapy.

Цель исследования — построение номограммы, прогнозирующей патологическую степень местной распространенности рака мочевого пузыря (РМП) рТ3−рТ4 (рТ3+) по клиническим данным.

Материалы и методы. Материалом послужили данные 511 пациентов с диагнозом РМП, которым в период с 1999 по 2008 г. в РНПЦ онкологии и медицинской радиологии была выполнена радикальная цистэктомия. Для прогнозирования вероятности наличия pT3+ по дооперационным данным использованы моновариантные и мультивариантные модели логистической регрессии. Коэффициенты уравнения логистической регрессии использованы для построения номограммы. Точность номограммы оценена индексом конкордации (с-index) и построением калибровочного графика. Выполнена внутренняя валидизация методом бутстрэп с использованием 200 вариантов наборов данных.

Результаты. Разработана номограмма, включающая предикторы: клиническая степень местной распространенности сТ, степень дифференцировки, характер роста опухоли, наличие уретерогидронефроза, поражение опухолью простатического отдела уретры и/или 1 или 2 долей предстательной железы, поражение 3 и более стенок мочевого пузыря, скорость оседания эритроцитов, уровень креатинина. Бутстрэп-скорректированная прогностическая точность разработанной номограммы составила 81,4 %, что на 12,6 % выше точности моновариантной модели, учитывающей только клиническую стадию.

Выводы. Применение разработанной номограммы позволяет существенно повысить точность предсказания патологической стадии опухоли, что может быть использовано при отборе пациентов для неоадъювантной терапии.

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