World Journal of Urology

, Volume 37, Issue 9, pp 1867–1877 | Cite as

Novel nomograms to predict recurrence and progression in primary non-muscle-invasive bladder cancer: validation of predictive efficacy in comparison with European Organization of Research and Treatment of Cancer scoring system

  • Hyung Suk Kim
  • Chang Wook Jeong
  • Cheol Kwak
  • Hyeon Hoe Kim
  • Ja Hyeon KuEmail author
Original Article



To develop and validate novel nomograms to predict recurrence and progression after transurethral resection of bladder tumor (TURBT) in Korean patients with non-muscle-invasive bladder cancer (NMIBC).


We retrospectively analyzed the clinical data on 970 newly diagnosed NMIBC patients after TURBT between 2000 and 2013 in a single institution. We used multivariate Cox proportional hazard models to identify the significant predictors of recurrence and progression, which resulted in the construction of the nomograms predicting the 5-year probability of recurrence and progression. We internally validated the nomograms using the area under the receiver-operating characteristics’ curves and calibration plots. In addition, the clinical usefulness of each nomogram was assessed and compared with that of the European Organization of Research and Treatment of Cancer (EORTC)-scoring system using decision curve analysis (DCA).


The significant factors related to recurrence were gross hematuria at diagnosis, previous or concomitant upper urinary tract urothelial carcinoma (UTUC), pT1 tumor, high tumor grade, multiple tumors, and intravesical therapy. The significant predictors of progression were previous or concomitant UTUC, pT1 tumor, high tumor grade, carcinoma in situ, and lymphovascular invasion. The 5-year predictive accuracy of each nomogram was 65% for recurrence and 70% for progression, respectively. Compared with the EORTC-scoring system, the nomograms were generally well calibrated. On DCA, each nomogram presented better net benefit gains than did the EORTC-scoring system across a wide range of threshold probabilities.


Our novel nomograms are not completely accurate, but they show a reasonable level of discriminative ability, adequate calibration, and meaningful net benefit gain for the prediction of recurrence and progression after TURBT in Korean NMIBC patients. Additional external validation will be required to generalize the nomograms which we developed.


Urinary bladder neoplasms Recurrence Disease progression Nomograms 



This study was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (Grant number: 2018R1C1B5086339).

Author contributions

Conception and design: HSK, JHK, CWJ, CK, and HHK. Data acquisition: HSK and JHK. Data analysis and interpretation: JHK and HSK. Manuscript drafting: HSK and JHK. Critical revision of the manuscript for scientific and factual content: JHK and HSK. Statistical analysis: HSK and JHK. Supervision: HSK, JHK, CWJ, CK, and HHK.

Compliance with ethical standards

Conflict of interest

There is no any conflict of interest to disclose among all authors.

Research involving human participants and/or animals

Prior to the initiation of the study, the use of patients’ data in this study was approved from institutional review board (IRB) of Seoul National University Hospital (IRB number: H-1506-063-679).

Informed consent

Owing to the retrospective feature of this study, the requirement for obtaining written informed consent from each patient was waived by the IRB of Seoul National University Hospital.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hyung Suk Kim
    • 1
  • Chang Wook Jeong
    • 2
  • Cheol Kwak
    • 2
  • Hyeon Hoe Kim
    • 2
  • Ja Hyeon Ku
    • 2
    Email author
  1. 1.Department of UrologyDongguk University Ilsan Medical Center, Dongguk University College of MedicineGoyangKorea
  2. 2.Department of Urology, Seoul National University HospitalSeoul National University College of MedicineSeoulKorea

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