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中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (05) : 645 -652. doi: 10.3877/cma.j.issn.1674-3253.2025.05.016

临床研究

肌层浸润性膀胱癌患者根治性膀胱切除术预后列线图模型的构建及验证
腾鹏1,†(), 田景昌2, 鄂春翔1, 向阳1, 田伯宇1   
  1. 1161000　黑龙江，齐齐哈尔市第一医院北院泌尿外科
    2116000　辽宁，大连大学附属新华医院泌尿外科
  • 收稿日期:2025-01-17 出版日期:2025-10-01
  • 通信作者: 腾鹏
  • 基金资助:
    齐齐哈尔市科技计划创新激励项目(CSFGG-2023042)

Development and validation of a prognostic nomogram model for patients with muscle-invasive bladder cancer after radical cystectomy

Peng Teng1,†(), Jingchang Tian2, Chunxiang E1, Yang Xiang1, Boyu Tian1   

  1. 1Department of Urology, North Hospital of the First Hospital of Qiqihar, Heilongjiang 161000, China
    2Department of Urology, Xinhua Hospital Affiliated to Dalian University, Liaoning 116000,China
  • Received:2025-01-17 Published:2025-10-01
  • Corresponding author: Peng Teng
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引用本文：

腾鹏, 田景昌, 鄂春翔, 向阳, 田伯宇. 肌层浸润性膀胱癌患者根治性膀胱切除术预后列线图模型的构建及验证[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(05): 645-652.

Peng Teng, Jingchang Tian, Chunxiang E, Yang Xiang, Boyu Tian. Development and validation of a prognostic nomogram model for patients with muscle-invasive bladder cancer after radical cystectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(05): 645-652.

目的

探讨肌层浸润性膀胱癌（MIBC）患者的预后因素，并通过整合肿瘤生物学特征、骨骼肌指数与营养评价参数开发一种新型预后模型，以帮助医师更好地预测临床结局并做出合理的治疗决策。

方法

回顾性分析2017年01月至2020年12月期间于齐齐哈尔市第一医院泌尿外科接受根治性膀胱切除术的302例MIBC患者的临床资料，将研究人群随机分为建模组（n=202）与验证组（n=100）。采用单、多变量Cox回归分析筛选影响MIBC患者总体生存（OS）的因素，构建列线图模型。模型的预测性能以一致性指数（C-index）与受试者工作特性（ROC）曲线进行评估。

结果

单、多变量Cox回归分析表明，cT分期（cT3期：HR=2.175，95%CI：1.467~3.224，P<0.001；cT4期：HR=3.433，95%CI：2.020~5.834，P<0.001）、淋巴结转移（HR=2.581，95%CI：1.794~3.712，P<0.001）、淋巴血管侵犯（HR=1.715，95%CI：1.184~2.484，P=0.042）、骨骼肌指数（HR=0.960，95%CI：0.937~0.983，P=0.001）与控制营养状态评分（HR=1.175，95%CI：1.099~1.256, P<0.001)是MIBC患者的独立预后因素。根据以上变量构建列线图的C-index为0.762（95%CI：0.711~0.798），ROC曲线显示该模型预测患者1年、2年和3年生存率的曲线下面积（AUC）分别为0.773、0.887和0.876。校准曲线显示模型预测结果和实际观察之间具有良好一致性。此外，该模型对MIBC患者预后的预测价值的内部验证，其C-index为0.744 （95%CI：0.702~0.787），预测1年、2年和3年生存率的AUC分别为0.793、0.840和0.833。

结论

基于肿瘤生物学特征、骨骼肌指数与营养评价参数开发的列线图模型，为准确预测MIBC患者预后提供了一种简便、有效的工具，有望帮助医师优化对患者的临床管理。

关键词: 肌层浸润性膀胱癌, 根治性膀胱切除, 控制营养状态, 预后营养指数, 骨骼肌指数, 预后, 预测, 列线图
Objective

To explore the prognostic factors of muscle-invasive bladder cancer (MIBC) patients, and develop a nomogram model based on tumor biological characteristics, skeletal muscle index and nutritional parameters, which may help surgeons to accurately predict clinical outcomes and make treatment decisions.

Methods

The clinical data of 302 MIBC patients who underwent radical cystectomy at the Department of Urology in Qiqihar First Hospital from January 2017 to December 2020 were retrospectively analyzed. The study population was randomly divided into the training group (n=202) and validation group (n=100). The univariate and multivariate Cox regression analysis were conducted to determine the predictors of overall survival (OS) for MIBC patients, and then a nomogram model was established. The predictive performance of the nomogram was evaluated by the consistency index (C-index) and receiver operation characteristic (ROC) curves, and calibration curves were plotted to evaluate its predictive accuracy.

Results

The data of univariate and multivariate Cox analysis indicated that cT stage (cT3 stage: HR=2.175, 95%CI: 1.467-3.224, P<0.001; cT4 stage: HR=3.433, 95%CI: 2.020-5.834, P<0.001), lymph node metastasis (HR=2.581, 95%CI: 1.794-3.712, P<0.001), lymphovascular invasion (HR=1.715, 95%CI: 1.184-2.484, P=0.042), skeletal muscle index (HR=0.960, 95%CI: 0.937-0.983, P=0.001) and controlling nutritional status (HR=1.175, 95%CI: 1.099-1.256, P<0.001) were independent prognostic factors for MIBC patients. A nomogram was developed according to the above five variables, with a C-index of 0.762 (95%CI: 0.711-0.798). The ROC curves showed that the area under curve (AUC) values of the nomogram for 1, 2, and 3 year survival prediction were 0.773, 0.887, and 0.876, respectively. The calibration curves showed a good consistency between the predicted probability and the actual observation. In addition, the predictive value of the nomogram model was further validated by an internal cohort. Its C-index was 0.744 (95%CI: 0.702-0.787), and the AUC values for 1, 2, and 3 year survival prediction were 0.793, 0.840, and 0.833, respectively.

Conclusion

The nomogram based on tumor biological characteristics, skeletal muscle index and nutritional parameters provides a simple and effective tool to accurately predict the survival outcome, and it might be helpful to optimize the clinical management of MIBC patients.

Key words: Muscle-invasive bladder cancer (MIBC), Radical cystectomy, CONUT, Prognostic nutritional index (PNI), Skeletal muscle index (SMI), Prognosis, Predictive, Nomogram
表1 控制营养状态（CONUT）评分
营养不良程度 正常 轻度 中度 重度
血清白蛋白(g/L) ≥35.0 30.0~34.9 25.0~29.9 <25.0
评分 0 2 4 6
总胆固醇(mg/dl) ≥180 140~179 100~139 <100
评分 0 1 2 3
淋巴细胞计数(×106) ≥1600 1 200~1 599 800~1 199 <800
评分 0 1 2 3
CONUT评分 0~1 2~4 5~8 9~12
表2 建模组与验证组肌层浸润性膀胱癌患者的基线特征
基线特征 建模组(n=202) 验证组(n=100) 统计值 P值
年龄[岁，(±s)] 68±9 66±9 t=1.631 0.104
性别[例(%)]     χ2=0.399 0.528
女 49 (24.3) 21 (21.0)    
男 153 (75.7) 79 (79.0)    
吸烟史[例(%)]     χ2=1.122 0.290
无 82 (40.6) 47 (47.0)    
有 120 (59.4) 53 (53.0)    
BMI[kg/m2，(±s)] 22.7±2.8 23.3±4.0 t=1.699 0.090
ASA分级[例(%)]     Z=0.631 0.729
Ⅰ 42 (20.8) 19 (19.0)    
Ⅱ 122 (60.4) 65 (65.0)    
Ⅲ 38 (18.8) 16 (16.0)    
肿瘤大小[例(%)]     χ2=0.104 0.748
≤5 cm 145 (71.8) 70 (70.0)    
>5 cm 57 (28.2) 30 (30.0)    
肿瘤个数[例(%)]     χ2=1.719 0.190
单发 187 (92.6) 88 (88.0)    
多发 15 (7.4) 12 (12.0)    
cT分期[例(%)]     Z=0.176 0.916
T2期 105 (52.0) 53 (53.0)    
T3期 79 (39.1) 37 (37.0)    
T4期 18 (8.9) 10 (10.0)    
淋巴结转移[例(%)]     χ2=0.576 0.448
否 142 (70.3) 66 (66.0)    
是 60 (29.7) 34 (34.0)    
新辅助化疗[例(%)]     χ2=0.015 0.902
否 140 (69.3) 70 (70.0)    
是 62 (30.7) 30 (30.0)    
淋巴血管侵犯[例(%)]     χ2=0.296 0.586
否 171 (84.7) 87 (87.0)    
是 31 (15.3) 13 (13.0)    
SMI[cm2/m2，(±s)] 44.2±7.5 44.0±7.1 t=0.179 0.858
NLR [M(Q)] 2.15 (1.57, 3.07) 2.27 (1.60，3.51) Z=1.326 0.185
PLR [M(Q)] 117.5 (97.4，142.6) 123.9 (103.5，156.7) Z=1.967 0.052
PNI [M(Q)] 45.5 (43.8，48.3) 43.1 (45.8，484) Z=0.183 0.854
CONUT评分[M(Q)] 2.0 (1.0，3.0) 2.0 (1.0，3.0) Z=0.087 0.930
表3 肌层浸润性膀胱癌患者根治术后预后因素的Cox回归分析
变量 单因素Cox分析 多因素Cox分析
HR（95%CI） P值 HR（95%CI） P值
年龄(岁) 1.019 (0.999~1.040) 0.069    
性别        
女 1      
男 1.065 (0.706~1.607) 0.764    
吸烟史        
无 1      
有 0.881 (0.626~1.240) 0.468    
BMI (kg/m2) 1.005 (0.957~1.055) 0.851    
ASA分级        
Ⅰ 1      
Ⅱ 0.866 (0.532~1.408) 0.561    
Ⅲ 0.825 (0.498~1.368) 0.456    
肿瘤大小        
≤5 cm 1      
> 5 cm 0.894 (0.606~1.321) 0.574    
肿瘤个数        
单发 1      
多发 0.781 (0.397~1.537) 0.474    
cT分期        
T2期 1      
T3期 2.026 (1.394~2.945) <0.001 2.175 (1.467~3.224) <0.001
T4期 4.749 (2.871~7.855) <0.001 3.433 (2.020~5.834) <0.001
淋巴结转移        
否 1      
是 3.371 (2.389~4.757) <0.001 2.581 (1.794~3.712) <0.001
新辅助化疗        
否 1      
是 0.610 (0.404~0.921) 0.019 1.022 (0.660~1.585) 0.921
淋巴血管侵犯        
否 1      
是 1.438 (1.020~2.029) 0.038 1.715 (1.184~2.484) 0.042
SMI (cm2/m2) 0.947 (0.925~0.970) <0.001 0.960 (0.937~0.983) 0.001
NLR 1.152 (1.081~1.277) <0.001 0.983 (0.952~1.015) 0.284
PLR 1.002 (1.000~1.004) 0.048 0.998 (0.996~1.001) 0.128
PNI 0.928 (0.906~0.951) <0.001 1.012 (0.965~1.062) 0.612
CONUT评分 1.231 (1.158~1.308) <0.001 1.175 (1.099~1.256) <0.001
图1 列线图预测根治性膀胱切除术治疗MIBC患者的生存结局
图2 列线图模型对建模组肌层浸润性膀胱癌患者预后的预测价值注：a为ROC曲线；b为校准曲线
图3 列线图模型对验证组肌层浸润性膀胱癌患者预后的预测价值注：a为ROC曲线；b为校准曲线
[1]
Lenis AT, Lec PM, Chamie K, et al. Bladder cancer[J]. Jama, 2020, 324(19): 1980. DOI: 10.1001/jama.2020.17598.
[2]
Alfred Witjes J, Bruins HM, Cathomas R, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines[J]. Eur Urol, 2021, 79(1): 82-104. DOI: 10.1016/j.eururo.2020.03.055.
[3]
Waraich TA, Khalid SY, Ali A, et al. Comparative outcomes of radical cystectomy in muscle-invasive bladder cancer: a systematic review and meta-analysis[J]. Cureus, 2023, 15(12): e50646. DOI: 10.7759/cureus.50646.
[4]
Kim IH, Lee HJ. Perioperative systemic treatment for muscle-invasive bladder cancer: current evidence and future perspectives[J]. Int J Mol Sci, 2021, 22(13): 7201. DOI: 10.3390/ijms22137201.
[5]
Struck JP, Hupe MC, Heinisch A, et al. RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer[J]. Aktuelle Urol, 2022, 53(6): 545-551. DOI: 10.1055/a-1310-3583.
[6]
Sharma M, Goto T, Yang Z, et al. The impact of perivesical lymph node metastasis on clinical outcomes of bladder cancer patients undergoing radical cystectomy[J]. BMC Urol, 2019, 19(1): 77. DOI: 10.1186/s12894-019-0507-z.
[7]
Claps F, van de Kamp MW, Mayr R, et al. Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy[J]. BJU Int, 2023, 132(2): 170-180. DOI: 10.1111/bju.15984.
[8]
Perera M, McGrath S, Sengupta S, et al. Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer[J]. Nat Rev Urol, 2018, 15(11): 686-692. DOI: 10.1038/s41585-018-0066-1.
[9]
Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer[J]. Clin Nutr, 2021, 40(5): 2898-2913. DOI: 10.1016/j.clnu.2021.02.005.
[10]
Wang J, Tan S, Gianotti L, et al. Evaluation and management of body composition changes in cancer patients[J]. Nutrition, 2023, 114: 112132. DOI: 10.1016/j.nut.2023.112132.
[11]
Jiao H, Wang L, Zhou X, et al. Prognostic ability of nutritional indices for outcomes of bladder cancer: a systematic review and meta-analysis[J]. Urol Int, 2023, 107(9): 886-894. DOI: 10.1159/000531884.
[12]
Wang J, Shi H, Fan Z, et al. Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle-invasive bladder cancer after surgery[J]. Cancer Med, 2023, 12(13): 14207-14224. DOI: 10.1002/cam4.6088.
[13]
Claps F, Mir MC, van Rhijn BWG, et al. Impact of the controlling nutritional status (CONUT) score on perioperative morbidity and oncological outcomes in patients with bladder cancer treated with radical cystectomy[J]. Urol Oncol, 2023, 41(1): 49.e13-49.e49.e22. DOI: 10.1016/j.urolonc.2022.09.023.
[14]
Nemoto Y, Kondo T, Ishihara H, et al. The controlling nutritional status CONUT score in patients with advanced bladder cancer after radical cystectomy[J]. In Vivo, 2021, 35(2): 999-1006. DOI: 10.21873/invivo.12343.
[15]
Jogiat UM, Sasewich H, Turner SR, et al. Sarcopenia determined by skeletal muscle index predicts overall survival, disease-free survival, and postoperative complications in resectable esophageal cancer: a systematic review and meta-analysis[J]. Ann Surg, 2022, 276(5): e311-e318. DOI: 10.1097/SLA.0000000000005452.
[16]
Abbass T, Tsz Ho YT, Horgan PG, et al. The relationship between computed tomography derived skeletal muscle index, psoas muscle index and clinical outcomes in patients with operable colorectal cancer[J]. Clin Nutr ESPEN, 2020, 39: 104-113. DOI: 10.1016/j.clnesp.2020.07.010.
[17]
Cicione A, Simone G, Lombardo R, et al. Development of a pocket nomogram to predict cancer and disease specific survival after radical cystectomy for bladder cancer: the CRAB nomogram[J]. Clin Genitourin Cancer, 2023, 21(1): 108-114. DOI: 10.1016/j.clgc.2022.08.011.
[18]
Necchi A, Pond GR, Moschini M, et al. Development of a prediction tool for exclusive locoregional recurrence after radical cystectomy in patients with muscle-invasive bladder cancer[J]. Clin Genitourin Cancer, 2019, 17(1): 7-14.e3. DOI: 10.1016/j.clgc.2018.09.008.
[19]
中华医学会泌尿外科学分会, 中国膀胱癌联盟, 黄健, 等. 根治性膀胱切除尿流改道术中国膀胱癌联盟共识[J]. 中华泌尿外科杂志, 2021(7): 481-484. DOI: 10.3760/cma.j.cn112330-20210607-00001.
[20]
Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients[J]. Nihon Geka Gakkai Zasshi, 1984, 85(9): 1001-1005.
[21]
Ignacio de Ulíbarri J, González-Madroño A, de Villar NP, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population[J]. Nutr Hosp, 2005, 20(1): 38-45.
[22]
Patel VG, Oh WK, Galsky MD. Treatment of muscle-invasive and advanced bladder cancer in 2020[J]. CA Cancer J Clin, 2020, 70(5): 404-423. DOI: 10.3322/caac.21631.
[23]
Martini A, Sfakianos JP, Renström-Koskela L, et al. The natural history of untreated muscle-invasive bladder cancer[J]. BJU Int, 2020, 125(2): 270-275. DOI: 10.1111/bju.14872.
[24]
Hensley PJ, Panebianco V, Pietzak E, et al. Contemporary staging for muscle-invasive bladder cancer: accuracy and limitations[J]. Eur Urol Oncol, 2022, 5(4): 403-411. DOI: 10.1016/j.euo.2022.04.008.
[25]
Munbauhal G, Drouin SJ, Mozer P, et al. Malnourishment in bladder cancer and the role of immunonutrition at the time of cystectomy: an overview for urologists[J]. BJU Int, 2014, 114(2): 177-184. DOI: 10.1111/bju.12529.
[26]
McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer[J]. Curr Opin Clin Nutr Metab Care, 2009, 12(3): 223-226. DOI: 10.1097/MCO.0b013e32832a7902.
[27]
Huang J, Zhao L, Wang K, et al. Controlling nutritional status score evaluates prognosis in patients with non-muscle invasive bladder cancer[J]. Cancer Control, 2021, 28: 10732748211021078. DOI: 10.1177/10732748211021078.
[28]
Xiong T, Ye X, Zhu G, et al. Prognostic value of Controlling Nutritional Status score for postoperative complications and biochemical recurrence in prostate cancer patients undergoing laparoscopic radical prostatectomy[J]. Curr Urol, 2024, 18(1): 43-48. DOI: 10.1097/CU9.0000000000000231.
[29]
Peng L, Meng C, Li J, et al. The prognostic significance of controlling nutritional status (CONUT) score for surgically treated renal cell cancer and upper urinary tract urothelial cancer: a systematic review and meta-analysis[J]. Eur J Clin Nutr, 2022, 76(6): 801-810. DOI: 10.1038/s41430-021-01014-0.
[30]
Niu X, Zhu Z, Bao J. Prognostic significance of pretreatment controlling nutritional status score in urological cancers: a systematic review and meta-analysis[J]. Cancer Cell Int, 2021, 21(1): 126. DOI: 10.1186/s12935-021-01813-2.
[31]
Bradshaw PT. Body composition and cancer survival: a narrative review[J]. Br J Cancer, 2024, 130(2): 176-183. DOI: 10.1038/s41416-023-02470-0.
[32]
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31. DOI: 10.1093/ageing/afy169.
[33]
Ha YS, Kim SW, Kwon TG, et al. Decrease in skeletal muscle index 1 year after radical cystectomy as a prognostic indicator in patients with urothelial bladder cancer[J]. Int Braz J Urol, 2019, 45(4): 686-694. DOI: 10.1590/S1677-5538.IBJU.2018.0530.
[34]
Engelmann SU, Pickl C, Haas M, et al. Body composition of patients undergoing radical cystectomy for bladder cancer: sarcopenia, low psoas muscle index, and myosteatosis are independent risk factors for mortality[J]. Cancers (Basel), 2023, 15(6): 1778. DOI: 10.3390/cancers15061778.
[35]
Yamashita S, Iguchi T, Koike H, et al. Impact of preoperative sarcopenia and myosteatosis on prognosis after radical cystectomy in patients with bladder cancer[J]. Int J Urol, 2021, 28(7): 757-762. DOI: 10.1111/iju.14569.
[36]
Lee S, Yoon Y, Suh J, et al. Association of preoperative sarcopenia with the long-term prognosis of patients with bladder cancer undergoing radical cystectomy[J]. J Cancer Res Clin Oncol, 2024, 150(4): 173. DOI: 10.1007/s00432-024-05705-6.
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