A Genomic-clinicopathologic Nomogram for the Preoperative Prediction of Lymph Node Metastasis in Bladder Cancer

Preoperative lymph node (LN) status is important for the treatment of bladder cancer (BCa). Here, we report a genomic-clinicopathologic nomogram for preoperatively predicting LN metastasis in BCa. In the discovery stage, 325 BCa patients from TCGA were involved and LN-status-related mRNAs were selected. In the training stage, multivariate logistic regression analysis was used to developed a genomic-clinicopathologic nomogram for preoperative LN metastasis prediction in the training set (SYSMH set, n=178). In the validation stage, we validated the nomogram using two independent sample sets (SYSUCC set, n=142; RJH set, n=104) with respect to its discrimination, calibration and clinical usefulness. As results, we identified five LN-status-related mRNAs, including ADRA1D, COL10A1, DKK2, HIST2H3D and MMP11. Then, a genomic classifier was developed to classify patients into high- and low-risk groups in the training set. Furthermore, a nomogram incorporating the five-mRNA-based classifier, image-based LN status, transurethral resection (TUR) T stage, and TUR lymphovascular invasion (LVI) was constructed in the training set, which performed well in the training and validation sets. Decision curve analysis demonstrated the clinical value of our nomogram. Thus, our genomic-clinicopathologic nomogram shows favorable discriminatory ability and may aid in clinical decision-making, especially for cN-patients. •A genomic classifier was built to classify bladder cancer patients into high- and low-risk groups of lymph node metastasis.•A genomic-clinicopathologic nomogram was developed for predicting lymph node metastasis in bladder cancer patients.•The nomogram shows favorable discrimination and calibration which may aid in clinical decision-making. Preoperative lymph node status is critical for guiding the management of bladder cancer patients. However, current preoperative nodal staging methods are inaccurate. Here, we proposed a user-friendly tool (nomogram) for the preoperative prediction of lymph node metastasis in bladder cancer, which showed good calibration and discrimination. The favorable predictive accuracy was validated in two external institutes. Thus, our nomogram could be an efficient and valuable tool for individual lymph node metastasis prediction and bladder cancer treatment decision making.