Development and Validation of an Improved Pathological Nodal Staging System for Urothelial Carcinoma of the Bladder Devin N. Patel, Michael Luu, Zachary.

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Development and Validation of an Improved Pathological Nodal Staging System for Urothelial Carcinoma of the Bladder Devin N. Patel, Michael Luu, Zachary S. Zumsteg, Timothy J. Daskivich European Urology Oncology DOI: 10.1016/j.euo.2018.12.012 Copyright © 2019 European Association of Urology Terms and Conditions

Fig. 1 Restricted cubic spline Cox model comparing hazard of overall mortality by (A) metastatic nodal count and (B) regional nodes examined. Adjusted hazard ratios (HRs) with an increasing number of positive lymph nodes (LNs) and LNs were examined. (A) The number of positive nodes was modeled as a restricted cubic spline with three nodes at 82nd, 88th, and 99th quantiles with an estimated change point found at four positive nodes. The predicted log relative hazard was plotted with a referent value of zero positive nodes. (B) The number of nodes examined was modeled as a linear predictor with an adjusted HR of 0.991 for every increasing node examined. The predicted log relative hazard was plotted with a referent value of five nodes examined. European Urology Oncology DOI: (10.1016/j.euo.2018.12.012) Copyright © 2019 European Association of Urology Terms and Conditions

Fig. 2 Novel proposed nodal staging system developed by recursive portioning analysis in bladder cancer patients who did not receive neoadjuvant chemotherapy. Bonferroni-adjusted p values are given in the inner nodes, and Kaplan-Meier estimates for 5-yr overall survival are displayed in the terminal nodes. LN=lymph node; OS=overall survival. European Urology Oncology DOI: (10.1016/j.euo.2018.12.012) Copyright © 2019 European Association of Urology Terms and Conditions

Fig. 3 Kaplan-Meier curves depicting overall survival by (A) current AJCC pathological nodal classification and (B) proposed pathological nodal classification in the NCDB. AJCC=American Joint Committee on Cancer; LN=lymph node; NCDB=National Cancer Database. European Urology Oncology DOI: (10.1016/j.euo.2018.12.012) Copyright © 2019 European Association of Urology Terms and Conditions

Fig. 4 (A) Kaplan-Meier curves depicting overall survival by the proposed pathological nodal classification in SEER dataset. (B) Calibration curve showing observed versus predicted 5-yr overall survival based on the novel staging system in SEER dataset. The calibration curve depicts observed (black), ideal (gray), and optimism-corrected (blue) calibration for survival at 60mo. Perfect calibration can be characterized by the gray ideal curve along the 45° line with a slope of 1. Predicted 60-mo survival corresponds to the predicted survival probability at 60mo, and the fraction surviving 60mo corresponds to the Kaplan-Meier survival estimates at 60mo. Overfitting can be characterized by the area below the ideal curve and underfitting by the area above the ideal curve. European Urology Oncology DOI: (10.1016/j.euo.2018.12.012) Copyright © 2019 European Association of Urology Terms and Conditions