Preoperative Influencing Factors Of Survival Prognosis Of Patients With Bladder Cancer Undergoing Orthotopic Neobladder Surgery And Establishment And Evaluation Of Nomogram Prediction Model

Objective(s): This study aims to explore the preoperative influencing factors of the overall survival of patients with bladder cancer undergoing orthotopic neobladder surgery,and build and verify the prediction model of the preoperative influencing factors of the overall survival of patients.Methods: Retrospective analysis was made on the clinical data of bladder cancer patients admitted to the Department of Urology in our hospital from January 2012 to November 2021.Data such as gender,age,BMI,smoking history,hypertension history,diabetes history,hydronephrosis,ASA score,blood routine test and biochemistry within one week before operation,tumor stage,histological grading,lymph node metastasis,operation method,new bladder type,etc.were collected.Cox proportional risk model analysis was used to screen independent prognostic factors through univariate and multivariate analysis,construct a nomograph prediction model,and use Bootstrap resampling to internally validate the model.Results: Univariate analysis showed that hydronephrosis(HR=3.654,P<0.001),PNI(HR=1.846,P=0.0101),GFR(HR=0.985,P=0.0002),T stage(HR=3.431,P<0.001),pathological grade(HR=0.334,P<0.001),and lymph node metastasis(HR=5.644,P<0.001)were factors that affected postoperative OS.The multivariate analysis showed that hydronephrosis(HR=2.688,P=0.0224),PNI(HR=1.823,P=0.0186),T stage(HR=2.475,P=0.0005),and lymph node metastasis(HR=2.936,P=0.0004)were independent influencing factors for OS in patients.Based on the literature and the results of this study,six variables(age,PNI,ASA score,hydronephrosis,T stage,and lymph node metastasis)were selected to construct a nomograph prediction model for predicting the overall survival of patients after surgery.Model discrimination evaluation: ROC analysis shows that the AUC values of OS predicted by the model for the first,third,and fifth years are 0.840(95% CI: 0.773-0.907),0.796(95% CI:0.722-0.869),and 0.835(95% CI: 0.765-0.904),respectively,which are greater than0.7,indicating that the model has good discrimination.Model calibration evaluation:Construct a calibration chart for the nomogram prediction model,and the results show that the actual value and predicted value in the calibration curve of the model prediction for 1,3,and 5 years of OS fit well.This indicates that the model has good calibration.Conclusion(s): Hydronephrosis,PNI,T stage,and lymph node metastasis are independent influencing factors for OS in patients.The predictive model for predicting postoperative OS,which includes age,PNI,ASA scores,hydronephrosis,T-stage,and lymph node metastasis,performs well,has good discrimination and calibration in internal validation,and has certain application value in clinical work.