Development of a Pocket Nomogram to Predict Cancer and Disease Specific Survival After Radical Cystectomy For Bladder Cancer: The CRAB Nomogram

Data from a consecutive series of 2395 patients with primitive or progression to muscle invasive bladder cancer (MIBC) undergoing to radical cystectomy and lymph nodes dissection in 5 centers were evaluated. A quick nomogram to predict death from cancer and relapse was developed. The nomogram showed to be effective and accurate in predicting both outcomes. The nomogram may improve communication with the patients. Objectives: To develop an easy tool to predict cancer specific (CSS) and disease-free survival (DFS) in patients with bladder cancer treated with radical cystectomy. Methods: Data from a consecutive series of 2395 patients with primitive or progression to muscle invasive bladder cancer (MIBC) undergone to radical cystectomy and lymph nodes dissection in 5 centers were evaluated. Using Cox proportional hazards analyses, the Cancer of the bladder risk assessment (CRAB) nomogram was generated. Accuracy of the nomogram was evaluated by Harrell's C test. Internal validation of the model was performed using 200 bootstraps. Results: Median age was 66 (IQR 58/73) years; 612/2395 (26%) patients presented an advanced pathological stage ( >= pT3a); 478/2395 (20%) presented positive lymph nodes. Overall, 729/2395 (30%) presented local or distant recurrence with a median DFS of 42 (IQR 14/89) months. Overall, 642/2395 (27%) died of bladder cancer with a median follow up of 48 (IQR 22/92) months. On univariate Cox proportional hazards analyses, age, stage, and lymph nodes density were a significant predictor of 3 and5 years CSS and DFS. Accuracy of the CRAB nomogram was 0.73 and 0.71 respectively. Conclusion: CRAB nomogram can be a practical and easily applicable tool that may help urologists to classify the long-ter m CSS and DFS of patients treated with radical cystectomy and to predict the oncological outcome.