Background
Materials and methods
Study population
Clinical variables | Description | Values |
---|---|---|
Age | Age of the patient at diagnosis | < 65 years or ≥ 65 years |
Sex | The gender of the patient | Male or female |
Race | The primary race of the person | White, black or others |
Grade | Describes the tumor’s resemblance to normal tissue (coded according to ICD-O-3) | Well differentiated, poorly differentiated or Unknown |
Tumor_Stage | NCDB analytic stage identifies the clinically or pathologically determined size and/or extension of the primary tumor (cT) as defined by the American Joint Committee on Cancer (AJCC) | High (Stage III, IV) or low (Stage I, II) |
Lymph_nodes | Identifies the clinically-determined absence or presence of regional lymph node metastasis and describes the corresponding extent as defined by the American Joint Committee on Cancer (AJCC) | Yes, no or unknown |
Histology | Indicate the pathological histology of tumor cells (coded according to ICD-O-3) | Transitional cell carcinoma, papillary urothelial carcinoma, small cell carcinoma or others |
Lymph_Vas_invasion | Indicate the presence or absence of tumor cells in lymphatic channels (other than lymph nodes) or blood vessels within the primary tumor as noted microscopically by the pathologist | Yes, no or unknown |
Met_Bone | Indicate the presence of distant involvement of bone at the time of diagnosis | Yes or no |
Met_Liver | Indicate the presence of distant involvement of liver at the time of diagnosis | Yes or no |
Met_Lung | Indicate the presence of distant involvement of lung at the time of diagnosis | Yes or no |
Surgery_Primary | Records the surgical procedure and approach performed to the primary site | Minimal invasive surgery, non-minimal invasive surgery or no surgery |
Chemotherapy | Records of chemotherapy administrated as first course treatment | Yes or no |
Radiation_Therapy | Anatomic target volume is directed at tumors lying within the substance of brain or its meninges | Yes or no |
Paliative_Care | Any care provided an effort to palliate or alleviate symptoms | Yes or no |
Brain_Confined_Met | Indicate the presence of distant involvement of brain only or brian combined with other organs at the time of diagnosis | Brain confined or non-brain confined |
CDCC_Score | Charlson/Deyo Score, a weighted score derived from the sum of the scores for each of the comorbid conditions listed in the Charlson Comorbidity Score Mapping Table (source http://dx.doi.org/10.17632/nn6y58v8vv.1#file-a72735e9-15b5-4a10-aef5-deddad2463e8) | 0–3 |
Surgery_Met | Records the surgical removal of distant lymph nodes or other tissues or organs beyond the primary site | Yes or no |
Compliance with ethical standards
Statistical analysis
Results
Clinicopathologic characteristics
Characteristics | Training set (%) | Internal testing set (%) | ||||
---|---|---|---|---|---|---|
Number of cases | High risk | Low risk | Number of cases | High risk | Low risk | |
Age | ||||||
< 65 years | 71 (42) | 32 (18.9) | 39 (23.1) | 22 (33.8) | 11 (16.9) | 11 (16.9) |
≥ 65 years | 98 (58) | 49 (29) | 49 (29) | 43 (66.2) | 21 (32.3) | 22 (33.8) |
Sex | ||||||
Male | 128 (75.7) | 63 (37.3) | 65 (38.5) | 47 (72.3) | 19 (29.2) | 28 (43.1) |
Female | 41 (24.3) | 18 (10.7) | 23 (13.6) | 18 (27.7) | 13 (20) | 5 (7.7) |
Race | ||||||
White | 148 (87.6) | 70 (41.4) | 78 (46.2) | 59 (90.8) | 29 (44.6) | 30 (46.2) |
Black | 16 (9.5) | 8 (4.7) | 8 (4.7) | 4 (6.2) | 3 (4.6) | 1 (1.5) |
Others | 5 (3) | 3 (1.8) | 2 (1.2) | 2 (3.1) | 0 (0) | 2 (3.1) |
Grade | ||||||
Well differentiated | 14 (8.3) | 10 (5.9) | 4 (2.4) | 1 (1.5) | 0 (0) | 1 (1.5) |
Poorly differentiated | 96 (56.8) | 39 (23.1) | 57 (33.7) | 39 (60) | 19 (29.2) | 20 (30.8) |
Unknown | 59 (34.9) | 32 (18.9) | 27 (16) | 25 (38.5) | 13 (20) | 12 (18.5) |
Histology | ||||||
TCC | 94 (55.6) | 49 (29) | 45 (26.6) | 38 (58.5) | 17 (26.2) | 21 (32.3) |
PUC | 42 (24.9) | 15 (8.9) | 27 (16) | 8 (12.3) | 5 (7.7) | 3 (4.6) |
SCC | 10 (5.9) | 3 (1.8) | 7 (4.1) | 7 (10.8) | 2 (3.1) | 5 (7.7) |
Others | 23 (13.6) | 14 (8.3) | 9 (5.3) | 12 (18.5) | 8 (12.3) | 4 (6.2) |
Tumor_Stage | ||||||
Low | 13 (7.7) | 7 (4.1) | 6 (3.6) | 4 (6.2) | 2 (3.1) | 2 (3.1) |
High | 156 (92.3) | 74 (43.8) | 82 (48.5) | 61 (93.8) | 30 (46.2) | 31 (47.7) |
Lymph_nodes | ||||||
No | 87 (51.5) | 39 (23.1) | 48 (28.4) | 33 (50.8) | 16 (24.6) | 17 (26.2) |
Yes | 36 (21.3) | 14 (8.3) | 22 (13) | 17 (26.2) | 9 (13.8) | 8 (12.3) |
Unknown | 46 (27.2) | 28 (16.6) | 18 (10.7) | 15 (23.1) | 7 (10.8) | 8 (12.3) |
Lymph_Vas_Invasion | ||||||
No | 31 (18.3) | 12 (7.1) | 19 (11.2) | 12 (18.5) | 5 (7.7) | 7 (10.8) |
Yes | 29 (17.2) | 13 (7.7) | 16 (9.5) | 6 (9.2) | 3 (4.6) | 3 (4.6) |
Unknown | 109 (64.5) | 56 (33.1) | 53 (31.4) | 47 (72.3) | 24 (36.9) | 23 (35.4) |
Met_Bone | ||||||
No | 112 (66.3) | 47 (27.8) | 65 (38.5) | 44 (67.7) | 26 (40) | 18 (27.7) |
Yes | 57 (33.7) | 34 (20.1) | 23 (13.6) | 21 (32.3) | 6 (9.2) | 15 (23.1) |
Met_Liver | ||||||
No | 129 (76.3) | 61 (36.1) | 68 (40.2) | 50 (76.9) | 25 (38.5) | 25 (38.5) |
Yes | 40 (23.7) | 20 (11.8) | 20 (11.8) | 15 (23.1) | 7 (10.8) | 8 (12.3) |
Met_Lung | ||||||
No | 100 (59.2) | 40 (23.7) | 60 (35.5) | 34 (52.3) | 16 (24.6) | 18 (27.7) |
Yes | 69 (40.8) | 41 (24.3) | 28 (16.6) | 31 (47.7) | 16 (24.6) | 15 (23.1) |
Surgery_Primary | ||||||
Minimal invasive | 65 (38.5) | 27 (16) | 38 (22.5) | 31 (47.7) | 19 (29.2) | 12 (18.5) |
No | 83 (49.1) | 48 (28.4) | 35 (20.7) | 29 (44.6) | 9 (13.8) | 20 (30.8) |
Non-minimal invasive | 21 (12.4) | 6 (3.6) | 15 (8.9) | 5 (7.7) | 4 (6.2) | 1 (1.5) |
Chemotherapy | ||||||
No | 97 (57.4) | 77 (45.6) | 20 (11.8) | 36 (55.4) | 28 (43.1) | 8 (12.3) |
Yes | 72 (42.6) | 4 (2.4) | 68 (40.2) | 29 (44.6) | 4 (6.2) | 25 (38.5) |
Radiation_Therapy | ||||||
No | 89 (52.7) | 50 (29.6) | 39 (23.1) | 38 (58.5) | 14 (21.5) | 24 (36.9) |
Yes | 80 (47.3) | 31 (18.3) | 49 (29) | 27 (41.5) | 18 (27.7) | 9 (13.8) |
Palliative_Care | ||||||
No | 122 (72.2) | 62 (36.7) | 60 (35.5) | 47 (72.3) | 21 (32.3) | 26 (40) |
Yes | 47 (27.8) | 19 (11.2) | 28 (16.6) | 18 (27.7) | 11 (16.9) | 7 (10.8) |
Brain_Confined_Met | ||||||
No | 67 (39.6) | 24 (14.2) | 43 (25.4) | 22 (33.8) | 13 (20) | 9 (13.8) |
Yes | 102 (60.4) | 57 (33.7) | 45 (26.6) | 43 (66.2) | 19 (29.2) | 24 (36.9) |
CDCC_Score | ||||||
0 | 116 (68.6) | 50 (29.6) | 66 (39.1) | 46 (70.8) | 23 (35.4) | 23 (35.4) |
1 | 37 (21.9) | 19 (11.2) | 18 (10.7) | 12 (18.5) | 8 (12.3) | 4 (6.2) |
2 | 10 (5.9) | 7 (4.1) | 3 (1.8) | 5 (7.7) | 1 (1.5) | 4 (6.2) |
3 | 6 (3.6) | 5 (3) | 1 (0.6) | 2 (3.1) | 0 (0) | 2 (3.1) |
Surgery_Met | ||||||
No | 144 (85.2) | 72 (42.6) | 72 (42.6) | 55 (84.6) | 25 (38.5) | 30 (46.2) |
Yes | 25 (14.8) | 9 (5.3) | 16 (9.5) | 10 (15.4) | 7 (10.8) | 3 (4.6) |
Feature selection via LASSO
Characteristics | Univariate analysis HR (95% CI) | P value | Multivariate analysis HR (95% CI) | P value |
---|---|---|---|---|
Age (< 65 years vs. ≥ 65 years) | 1.117 (0.819–1.525) | 0.48 | 1.032 (0.705–1.511) | 0.87 |
Sex (male vs. female) | 0.861 (0.602–1.233) | 0.42 | 1.166 (0.756–1.797) | 0.49 |
Race | ||||
White vs. black | 0.871 (0.509–1.489) | 0.61 | 0.956 (0.523–1.747) | 0.88 |
White vs. others | 0.889 (0.363–2.174) | 0.80 | 0.524 (0.197–1.39) | 0.19 |
Grade | ||||
Well differentiated vs. poorly differentiated | 0.896 (0.511–1.574) | 0.70 | 1.317 (0.653–2.656) | 0.44 |
Well differentiated vs. unknown | 1.144 (0.636–2.057) | 0.65 | 1.634 (0.753–3.546) | 0.21 |
Histology | ||||
TCC vs. PUC | 0.851 (0.588–1.232) | 0.39 | 1.181 (0.738–1.89) | 0.49 |
TCC vs. SCC | 1.083 (0.563–2.087) | 0.81 | 1.495 (0.714–3.13) | 0.29 |
TCC vs. others | 0.916 (0.578–1.45) | 0.71 | 0.629 (0.363–1.09) | 0.10 |
Lymph_nodes | ||||
No vs. yes | 0.835 (0.564–1.234) | 0.37 | 0.808 (0.51–1.28) | 0.36 |
No vs. unknown | 0.985 (0.682–1.422) | 0.93 | 0.761 (0.485–1.196) | 0.24 |
Lymph_Vas_Invasion | ||||
No vs. yes | 1.098 (0.658–1.832) | 0.72 | 1.494 (0.816–2.736) | 0.19 |
No vs. unknown | 1.291 (0.859–1.94) | 0.22 | 1.269 (0.764–2.107) | 0.36 |
Tumor_Stage (low vs. high) | 1.247 (0.704–2.21) | 0.45 | 1.089 (0.536–2.211) | 0.81 |
Met_Bone (no vs. yes) | 1.026 (0.742–1.42) | 0.88 | 0.61 (0.374–0.997) | 0.05 |
Met_Liver (no vs. yes) | 0.978 (0.683–1.4) | 0.90 | 1.223 (0.761–1.966) | 0.41 |
Met_Lung (no vs. yes) | 1.317 (0.962–1.802) | 0.09 | 0.878 (0.525–1.469) | 0.62 |
Surgery primary | ||||
Minimal invasive surgery vs. no surgery | 1.44 (1.031–2.011) | 0.03 | 2.529 (1.609–3.975) | < 0.001 |
Minimal invasive surgery vs. non-minimal invasive | 0.923 (0.558–1.525) | 0.75 | 1.253 (0.672–2.334) | 0.48 |
Chemotherapy (no vs. yes) | 0.353 (0.25–0.498) | < 0.001 | 0.213 (0.137–0.332) | < 0.001 |
Radiation_Therapy (no vs. yes) | 0.723 (0.53–0.986) | 0.04 | 0.708 (0.486–1.031) | 0.07 |
Palliative_Care (no vs. yes) | 0.922 (0.651–1.305) | 0.65 | 0.631 (0.413–0.964) | 0.03 |
Brain_Confined_Met (non–brain confined vs. brain confined) | 1.248 (0.911–1.71) | 0.17 | 2.229 (1.144–4.345) | 0.02 |
CDCC_Score | ||||
0 vs. 1 | 1.29 (0.886–1.878) | 0.18 | 1.439 (0.929–2.23) | 0.10 |
0 vs. 2 | 1.529 (0.798–2.926) | 0.20 | 1.865 (0.861–4.038) | 0.11 |
0 vs. 3 | 2.14 (0.932–4.91) | 0.07 | 2.545 (1.035–6.256) | 0.04 |
Surgery_Met (yes vs. no) | 0.9 (0.58–1.396) | 0.64 | 0.918 (0.546–1.542) | 0.75 |
Development and validation of the prognostic nomogram
Clinical variables | Values | Risk points |
---|---|---|
Radiation_Therapy | No | 56 |
Yes | 42 | |
Palliative_Care | No | 56 |
Yes | 40 | |
Brain_Confined_Met | Non-brain confined | 73 |
Brain confined | 56 | |
CDCC_Score | 1 | 56 |
2 | 74 | |
3 | 76 | |
4 | 100 | |
Surgery_Primary | No | 90 |
Minimal invasive | 56 | |
Non-minimal invasive | 53 | |
Chemotherapy | No | 56 |
Yes | 0 |