Are Nomograms Better Than Currently Available Stage Groupings for Bladder Cancer?

Bladder cancer is a highly aggressive neoplasm. It is the fourth most frequent solid tumor among men and the seventh most frequent solid tumor among women, with more than 350,000 new cases diagnosed annually worldwide. 1 Radical cystectomy with orthotopic bladder substitution is the preferred treatment for invasive transitional cell carcinoma. With the advent of orthotopic bladder substitution after cystectomy, the majority of fit patients are no longer burdened with external ileal conduits or cutaneous ureterostomies. Progress in operating techniques and postoperative care has also contributed to improvements in survival. However, after cystectomy, 5-year survival in major series ranges from 35% to 50%, but may also be as high as 65% when a high proportion of good prognosis pT2 patients are included. [2] 3][4][5] High-risk patients with pT3-pT4 and/or pN, M0 bladder cancer have a worse prognosis, and 5-year survival ranges between 25% to 35%. Histologic grade and TNM staging have been the most universally used methodologies to predict the risk of recurrence after cystectomy.