Construction of the nomogram model based on controlling nutritional status for predicting tumor recurrence in nonmuscular invasive bladder cancer patients
Objective To investigate the predictive value of controlling nutritional status(CO-NUT)score for the recurrence of non-muscle invasive bladder cancer(NMIBC)patients,and establish a nomogram model based on CONUT score to evaluate its predictive performance.Methods The clini-cal data of 164 NMIBC patients admitted to our hospital from January 2017 to January 2020 were ana-lyzed retrospectively,and the optimal cutoff value of CONUT score was determined by the receiver op-eration characteristics(ROC)curve.According to CONUT score,the patients were divided into high CONUT score group(73 cases)and low CONUT score group(71 cases).Kaplan-Meier curve and Cox proportional hazard regression model were used to evaluate the predictive value of CONUT score for re-currence-free survival(RFS)of NMIBC patients.Based on the significant variables identified by the multivariate Cox analysis,an nomogram model was developed and C-index and calibration curves were used to evaluate its predictive performance for tumor recurrence.Results The best cut-off value of CONUT score for predicting RFS in NMIBC patients was determined to be 2 points(AUC=0.704,95％CI:0.626-0.782).The number of multiple tumors,lymphatic vascular invasion(LVI)in high CONUT score group were higher than those in low CONUT score group,serum albumin,peripheral blood lymphocyte count and serum total cholesterol were lower than those in low CONUT score group(all P＜0.05).Local tumor recurrence was observed in 77 patients(47.0％)during follow-up,Kap-lan-Meier survival curve results showed a significant association between high preoperative CONUT score and poor RFS in patients with NMIBC.The 3-year RFS of patients with low CONUT score group and high CONUT score group were 60.3％and 34.9％,respectively,and the difference was statisti-cally significant(x2=16.219,P＜0.001).Tumor maximum diameter,pathological grade,T stage,LVI and CONUT score were all influencing factors of RFS in NMIBC patients(all P＜0.05).Multiva-riate Cox regression analysis showed that maximum tumor diameter ≥3 cm and LVI and CONUT score≥2 were independent predictors of RFS in NMIBC patients(all P＜0.05).The nematic model predicted a C index of 0.711(95％CI:0.649-0.823)for the patient's RFS,with an AUC of 0.748,0.720,and 0.695 for 1-year,3-year,and 5-year RFS,respectively.The calibration curve shows no significant deviation between the 1-year,3-year,and 5-year RFS predicted by the nomogram model and the ideal forecast.Conclusions CONUT score was an effective tool to predict NMIBC recurrence after initial treatment,and its nomogram model might provide an individualized risk stratification for NMIBC patients and help clinicians make early intervention.
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