Development of a Nomogram That Predicts Outcomes After Radical Cystectomy for Bladder Cancer Using Data from Siriraj Hospital, Thailand

Kanawut Sooksatian; Kantima Jongjitaree; Thitipat Hansomwong; Varat Woranisarakul; Patkawat Ramart; Siros Jitpraphai; Ekkarin Chotikawanich; Tawatchai Taweemonkongsap

doi:10.33192/smj.v78i3.279910

Authors

Kanawut Sooksatian Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Kantima Jongjitaree Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Thitipat Hansomwong Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Varat Woranisarakul Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Patkawat Ramart Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Siros Jitpraphai Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Ekkarin Chotikawanich Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Tawatchai Taweemonkongsap Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

DOI:

https://doi.org/10.33192/smj.v78i3.279910

Keywords:

Nomogram, Cystectomy, Bladder cancer, Prognostic, Survival

Abstract

Objective: This study aimed to develop and validate a prognostic nomogram to estimate individualized overall survival (OS) for bladder cancer patients in Thailand undergoing radical cystectomy (RC), using data from Siriraj Hospital.

Materials and Methods: We retrospectively analyzed a cohort of 304 bladder cancer patients who underwent RC at Siriraj Hospital between 2012 and 2023. The patients were randomly allocated to the training (80%) and testing (20%) cohorts. Cox regression analyses were employed to identify predictors of OS from a range of clinical, pathological, and treatment-related variables. A prognostic nomogram was subsequently constructed and its performance was validated using the concordance index and the area under the receiver operating characteristic curve (AUC).

Results: The median patient age was 68 years and the majority of patients presented with muscle invasive disease. The median duration of follow-up was 61 months, with a median overall survival of 51 months. Multivariate analysis identified five independent predictors of OS: age, preoperative glomerular filtration rate, type of urinary diversion, pathological N stage, and presence of lymphovascular invasion. The nomogram demonstrated strong predictive performance, with AUC values of 86.6% at 12 months, 84.0% at 36 months, and 76.6% at 60 months.

Conclusion: We have developed and validated a prognostic nomogram tailored for Thai bladder cancer patients undergoing RC. This tool provides individualized survival estimates and may be a valuable aid in patient counseling, risk stratification, and formulation of postoperative management strategies. Future multicenter validation and integration of molecular markers will enhance the clinical utility of the prognostic nomogram.

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