Incidence trends and survival prediction of urothelial cancer of the bladder: a population-based study

Abstract

Background: The aim of this study is to determine the incidence trends of urothelial cancer of the bladder (UCB) and to develop a nomogram for predicting the cancer-specific survival (CSS) of postsurgery UCB at a population-based level based on the SEER database. Methods: The age-adjusted incidence of UCB diagnosed from 1975 to 2016 was extracted, and its annual percentage change was calculated and joinpoint regression analysis was performed. A nomogram was constructed for predicting the CSS in individual cases based on independent predictors. The predictive performance of the nomogram was evaluated using the consistency index (C-index), net reclassification index (NRI), integrated discrimination improvement (IDI), a calibration plot and the receiver operating characteristics (ROC) curve. Results: The incidence of UCB showed a trend of first increasing and then decreasing from 1975 to 2016. However, the overall incidence increased over that time period. The age at diagnosis, ethnic group, insurance status, marital status, differentiated grade, AJCC stage, regional lymph nodes removed status, chemotherapy status, and tumor size were independent prognostic factors for postsurgery UCB. The nomogram constructed based on these independent factors performed well, with a C-index of 0.823 and a close fit to the calibration curve. Its prediction ability for CSS of postsurgery UCB is better than that of the existing AJCC system, with NRI and IDI values greater than 0 and ROC curves exhibiting good performance for 3, 5, and 8 years of follow-up. Conclusions: The nomogram constructed in this study might be suitable for clinical use in improving the clinical predictive accuracy of the long-term survival for postsurgery UCB.