Development and Validation of a Prognostic Nomogram for Predicting Cancer-Specific Survival in Patients With Lymph Node Positive Bladder Cancer: A Study Based on SEER Database

PURPOSE: To construct a prognostic model to predict the cancer-specific survival (CSS) for bladder cancer patients with lymph node-positive. PATIENTS AND METHODS: We enrolled 2,050 patients diagnosed with lymph node-positive bladder cancer from the Surveillance Epidemiology and End Results (SEER) database (2004–2015). All patients were randomly split into development cohort (n = 1,438) and validation cohort (n = 612) at a ratio of 7:3. The univariate and multivariate Cox regression analysis were performed to identify prognostic factors. A nomogram predicting CSS was established based on the results of multivariate Cox analysis. Its performance was evaluated by calibration curves, the receiver operating characteristic (ROC) curves, and the concordance index (C-index). Internal verification was performed in the validation cohort. The Kaplan–Meier method with the log-rank test was applied in the different risk groups. RESULTS: The nomogram incorporated summary stage, tumor size, chemotherapy, regional nodes examined and positive lymph nodes. The C-index of the nomogram in the development cohort was 0.716 (0.707–0.725), while the value of the C-index was 0.691 (0.689–0.693) in the validation cohort. The AUC of the nomogram was 0.803 for 3-year and 0.854 for 5-year in the development cohort, while was 0.773 for 3-year and 0.809 for 5-year in the validation cohort. Calibration plots for 3-year and 5-year CSS showed good concordance. Significant differences were observed between high, medium, and low risk groups (P <0.001). CONCLUSIONS: We have established a prognostic nomogram providing an accurate individualized probability of cancer-specific survival in bladder cancer patients with lymph node-positive. The nomogram could contribute to patient counseling, follow-up scheduling, and selection of treatment.