Nomogram Estimates Risk of Cardiovascular-Related Mortality in Bladder Cancer

Researchers developed an approach to predicting long-term cardiovascular disease (CVD)-related mortality in patients with bladder cancer (BC). They described this approach in a recent article in the journal Frontiers in Cardiovascular Medicine.

“Given that [bladder cancer] patients have the highest risk of dying from CVD among 28 cancer types, it is imperative to enhance the management of CVD in this patient population,” the researchers wrote in their report. 

The researchers obtained data on patients with a bladder cancer diagnosis using the Surveillance, Epidemiology, and End Results (SEER) database. Records were collected for those with diagnoses between 2000 and 2017. 

The researchers performed a variety of analyses to identify factors associated with CVD-related death to develop a nomogram, or tool, for predicting long-term CVD-related death in this population. For these analyses, patients were randomly assigned into either a training cohort for model development or a validation cohort for testing the model.

A total of 129,765 patients were included in the analysis overall, of whom 70% were allocated to the training cohort and 30% were allocated to the validation cohort. Overall, 31,862 (46.4%) of the patients died from bladder cancer, while 36,793 (53.6%) died of noncancer causes. Among those with a noncancer cause of death, nearly half (17,165 [46.7%]) were CVD-related deaths.

In a multivariate analysis, the researchers found that independent risk factors for CVD-related death in this population included age, sex, race, marital status, histologic type, tumor grade, summary stage, and use of chemotherapy. A model based on these factors demonstrated a good ability to discriminate between outcomes, with reportedly high consistency and clinical practicability. It should be noted that in this study the use of chemotherapy was associated with a reduced CVD risk, compared with not using chemotherapy.

For analyzing probabilities of CVD-related death over time, this model performed well according to a statistic used for evaluating a model’s discriminative performance. Additionally, prediction probabilities tended to be consistent with observed probabilities. Results also showed the model appeared to have high positive net benefits, suggesting a high clinical application value and predictive potential.

“With the help of this well-established nomogram, urologists and cardiologists could work together to comprehensively assess the potential risks of treatment, providing early monitoring and prevention of heart damage, thereby minimizing factors that are harmful to a patient’s cardiovascular prognosis,” the researchers concluded.

Reference

Liao J, Zhou Z. Long-term cardiovascular mortality risk in patients with bladder cancer: a real-world retrospective study of 129,765 cases based on the SEER database. Front Cardiovasc Med. 2023:10:1142417. doi:10.3389/fcvm.2023.1142417