Prognostic Nutritional Index Combined With NLR To Construct A Survival Prediction Model And Decision Analysis Of Patients With Muscle-invasive Bladder Cancer After Surgery

Objectives: To discuss the risk causes affecting the overall survival of patients with muscle-invasive bladder cancer after radical cystectomy,combined PNI and NLR to form a nomogram prediction model,and evaluate its predictive value and survival decision analysis.Methods: Retrospective analysis of the clinical data of 262 patients with radical cystectomy muscle-invasive bladder cancer admitted to the Department of Urology,Second Affiliated Hospital of Kunming Medical University from July 2015 to August2021.The final included model variables were determined by single-cause Cox stepwise regression,ideal subset regression and LASSO regression + cross-validation with the minimum AIC value.Multi-cause Cox regression analysis was then performed.The independent risk causes screened for their influence on the survival of patients with radical resected muscle-invasive bladder cancer were fitted to frame a nomogram model.Receiver Operating Characteristic curves assessed the predictive accuracy,truth,and clinical benefit of the model,C-index,calibrate plot,and decision curve analysis.Bootstrap Kaplan-Meier survival analysis was then carried out for each risk cause to calculate 1-year,3-year,and 5-year survival rates,respectively.Results: 262 eligible patients were included,with a follow-up time of 2-83 months and a median follow-up time of 32 months,of whom 91 patients(34.73%)died and171 patients(65.27%)survived.Results of the multicausal analysis,age(HR=1.06,95%CI:[1.04,1.08],P<0.001),pre-operative hydronephrosis(HR=0.69,95%CI:[0.46,1.05],P=0.087,based on clinical experience and previous studies included in the model),T-stage(HR=2.06,95%CI:[1.09,3.93],P=0.027),LVI(HR=1.73,95%CI:[1.12,2.67],P=0.013),PNI(HR=1.70,95%CI: [1.09,2.63],P=0.018),and NLR(HR=0.52,95%CI:[0.29,0.93],P=0.026)were independent risk causes for survival in patients with bladder cancer.Based on the above results,the Nomogram was constructed,and the ROC curves for 1-year OS,3-year OS,and 5-year OS were plotted based on the Nomogram;the area under the ROC curves,i.e.ACU values,was0.811(95% CI :[0.752,0.869]),0.814(95% CI: [0.755,0.873]),0.787(95%CI:[0.708,0.865 ]),the calibrate plot showed a good fit between the predicted and actual values;the calibrate plot of the Bootstrap resampling 1000 times to confirm the model was similar to the fundamental importance;the decision curve analysis at 1,3and 5 years were above the ALL,and None lines at thresholds of >5%,5%-70%,and20%-70%,respectively,and the model had better clinical applicability.Kaplan-Meier survival analysis for each variable suggested poorer survival in patients with pre-operative combined Hydronephrosis,higher T-stage,combined LVI,low PNI,and high NLR.Conclusions: In this study,PNI and NLR were found to be independent risk factors affecting the overall survival of patients with muscle-invasive bladder cancer after radical surgery,which can provide better guidance value for the prognosis of muscle-invasive bladder cancer.However,further validation in large multicentre clinical studies is needed.