External validation of models for prediction of lymph node metastasis in urothelial carcinoma of the bladder

Ja Hyeon Ku, Myong Kim, Seok Soo Byun, Hyeon Jeong, Cheol Kwak, Hyeon Hoe Kim, Sang Eun Lee

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5 Scopus citations


Purpose: To externally validate models to predict LN metastsis; Karakiewicz nomogram, clinical nodal staging score (cNSS), and pathologic nodal staging score (pNSS) using a different cohort Materials and Methods: Clinicopathologic data from 500 patients who underwent radical cystectomy and pelvic lymphadenectomy were analyzed. The overall predictive values of models were compared with the criteria of overall performance, discrimination, calibration, and clinical usefulness. Results: Presence of pN+ stages was recorded in 117 patients (23.4%). Agreement between clinical and pathologic stage was noted in 174 (34.8%). Based on Nagelkerke's peudo-R2 and brier score, pNSS demonstrated best overall performance. Area under the receiver operating characteristics curve, showed that pNSS had the best discriminatory ability. In all models, calibration was on average correct (calibration-in-the-large coefficient = zero). On decision curve analysis, pNSS performed better than other models across a wide range of threshold probabilities. Conclusions: When compared to pNSS, current precystectomy models such as the Karakiewicz nomogram and cNSS cannot predict the probability of LN metastases accurately. The findings suggest that the application of pNSS to Asian patients is feasible.

Original languageEnglish
Article numbere0120552
JournalPLoS ONE
Issue number10
StatePublished - 1 Oct 2015

Bibliographical note

Publisher Copyright:
© 2015 Ku et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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