Pd09-04 prediction of 90-day mortality after radical cystectomy for bladder cancer in large-scale multicenter collaboration study

You have accessJournal of UrologyCME1 Apr 2023PD09-04 PREDICTION OF 90-DAY MORTALITY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER IN LARGE-SCALE MULTICENTER COLLABORATION STUDY Ekaterina Laukhtina, Elisabeth Maier, Victor M. Schuettfort, Chiara Lonati, Francesco Soria, Simone Albisinni, Wojciech Krajewski, Giuseppe Basile, Guillaume Ploussard, Jeremy Yuen-Chun Teoh, Benjamin Pradere, David D`Andrea, Keiichiro Mori, Rafael Sanchez Salas, M. Carmen Mir, Claudio Simeone, Stefania Zamboni, Agostino Mattei, Roberto Carando, Margit Fisch, Evanguelos Xylinas, Matthias May, Florian Roghmann, Dmitry Enikeev, Alberto Briganti, Francesco Montorsi, Shahrokh F. Shariat, Marco Moschini, and Atiqullah Aziz Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Elisabeth MaierElisabeth Maier More articles by this author , Victor M. SchuettfortVictor M. Schuettfort More articles by this author , Chiara LonatiChiara Lonati More articles by this author , Francesco SoriaFrancesco Soria More articles by this author , Simone AlbisinniSimone Albisinni More articles by this author , Wojciech KrajewskiWojciech Krajewski More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Guillaume PloussardGuillaume Ploussard More articles by this author , Jeremy Yuen-Chun TeohJeremy Yuen-Chun Teoh More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , David D`AndreaDavid D`Andrea More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Rafael Sanchez SalasRafael Sanchez Salas More articles by this author , M. Carmen MirM. Carmen Mir More articles by this author , Claudio SimeoneClaudio Simeone More articles by this author , Stefania ZamboniStefania Zamboni More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Roberto CarandoRoberto Carando More articles by this author , Margit FischMargit Fisch More articles by this author , Evanguelos XylinasEvanguelos Xylinas More articles by this author , Matthias MayMatthias May More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Dmitry EnikeevDmitry Enikeev More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Marco MoschiniMarco Moschini More articles by this author , and Atiqullah AzizAtiqullah Aziz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several models for the prediction of 90d mortality after radical cystectomy (RC) based on preoperative parameters have been introduced. This study aimed to externally validate the performance of the existing nomograms and to select the most valuable predictors addressing 90d mortality after RC using a machine-learning-based approach to ultimately help improve outcome prediction in a preoperative setting. METHODS: Data of 3,816 bladder cancer patients treated with RC have been retrospectively collected from 25 tertiary referral centers. The abilities of the PROMETRICS2011, Morgan, and Taylor nomograms to predict postoperative 90d mortality were tested. Further, patients were randomly divided into development and validation cohorts. A machine-learning-based variable selection approach (LASSO regression) was used for the fitting of the most informative, yet parsimonious multivariable model to predict 90d mortality after RC. The discriminatory ability of the model was quantified by the area under the curve (AUC) of receiver operating curves (ROC). After validation of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate its clinical net-benefit. RESULTS: A total of 269 patients (7%) experienced 90d mortality. During external validation of the existing models in our study population, the PROMETRICS nomogram showed discrimination for predicting individual 90-d mortality with an accuracy of 70.3%. The Morgan and Taylor nomograms showed an accuracy of 67.2% and 61.3%, respectively. Our new model comprised ASA score, clinically metastatic disease, albumin, and eGFR as selected by the machine-learning process to be of high discriminatory power. In the development cohort, the newly developed model had an AUC of 80% whereas the validation cohort showed an AUC of 65%, respectively. In sensitivity analysis including only non-metastatic patients, the AUC addressing 90d mortality after RC was 72%. CONCLUSIONS: Our newly developed model for the prediction of 90d mortality after RC outperformed currently available nomograms within a large contemporary cohort. It can be used in a preoperative setting with easily assessable variables for preoperative patient counselling and risk stratification. However, external validation is warranted before clinical use. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e240 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ekaterina Laukhtina More articles by this author Elisabeth Maier More articles by this author Victor M. Schuettfort More articles by this author Chiara Lonati More articles by this author Francesco Soria More articles by this author Simone Albisinni More articles by this author Wojciech Krajewski More articles by this author Giuseppe Basile More articles by this author Guillaume Ploussard More articles by this author Jeremy Yuen-Chun Teoh More articles by this author Benjamin Pradere More articles by this author David D`Andrea More articles by this author Keiichiro Mori More articles by this author Rafael Sanchez Salas More articles by this author M. Carmen Mir More articles by this author Claudio Simeone More articles by this author Stefania Zamboni More articles by this author Agostino Mattei More articles by this author Roberto Carando More articles by this author Margit Fisch More articles by this author Evanguelos Xylinas More articles by this author Matthias May More articles by this author Florian Roghmann More articles by this author Dmitry Enikeev More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Shahrokh F. Shariat More articles by this author Marco Moschini More articles by this author Atiqullah Aziz More articles by this author Expand All Advertisement PDF downloadLoading ...