Construction And Evaluation Of NMIBC Recurrence Risk Score Model Based On Three-dimensional Data Of CT Images

Objective:Based on CT image data of patients with non-muscle invasive bladder cancer (NMIBC),three-dimensional reconstruction was performed.Two parameters of tumor volume and tumor surface area were introduced to explore their relationship with tumor recurrence,and a new scoring model was constructed accordingly.Methods:A retrospective analysis was performed on 50 patients with NMIBC from December1,2017 to December 1,2018,in the Department of Urology,First Hospital of Shanxi Medical University.The clinical data and CT imaging data of the patients during their admission were collected,and the bladder tumors were three-dimensionally reconstructed using Mimics Research software to obtain the tumor volume and surface area of the patients.The ICC consistency test was used to evaluate the repeatability of the operation.The univariate and multivariate Cox proportional hazard regression analysis was used to explore the relationship between tumor volume,tumor surface area and recurrence risk,and independent risk factors were screened out.The bladder was developed based on the regression coefficient and HR The tumor recurrence risk score table divides NMIBC patients into different recurrence risk groups according to the distribution of scores.Draw the ROC curve of the scoring model and EORTC scoring system,and evaluate the validity and clinical application value of the model.Results:Among the 50 subjects,40 were male(80.0%),10 were female(20.0%),aged 40-81years,the average age was 62.220±10.504 years,and 44%(22/50)of patients had a single tumor 78%(39/50)of patients had a tumor size of<3cm,80%(40/50)of patients had a primary tumor,18%(9/50)of patients had carcinoma in situ(CIS).One year later,the tumor recurrence rate was 56%(28/50),the median time to recurrence was 9 months,and42.9%(12/28)patients relapsed 9 months after surgery.The ICC indices of tumor volume and surface area obtained by the two reconstructions were 0.970 and 0.988(>0.75),respectively,and the consistency was high.Univariate and multivariate Cox proportional hazard regression analysis showed the number of tumors(risk ratio HR=1.640,95%CI:0.498-3.843,P=0.035),tumor recurrence frequency(HR=3.315,95%CI:1.844-5.960,P<0.0001),tumor volume(HR=1.738,95%CI:0.489-4.266,P=0.042),tumor surface area(HR=1.884,95%CI:0.502-5.475,P=0.046)were independent risk factors for tumor recurrence.Based on the regression coefficient and HR value,the scores of each factor are given:number of tumors 2 points(1 0 points;2-7 1 points;≥8 2 points);tumor recurrence frequency 4 points(primary 0 points;1 rec/year 2 points;>1rec/year 4 points;tumor volume 2 points(<9cm~30 points;9-13cm~31 point;≥13cm~32 points);tumor surface area 2 points(<18cm~20 points;18-37cm~21 point;≥37cm~22 points).According to the distribution of patients’scores,0-1 points were classified as low-risk recurrence risk group;2-4 points were classified as intermediate-risk recurrence risk group,and 5-10 points were classified as high-risk recurrence risk group.The ROC curve shows that the AUC value of the scoring model is 0.705(>0.70)and the AUC value of the EORTC scoring system is 0.765(>0.70).Comparing the area under the two curves,a P value of 0.5537(>0.05)is obtained.There is no difference in the predictive power of the two,which has certain clinical application value.Conclusion:The volume and surface area of bladder tumors in NMIBC patients are independent risk factors for postoperative recurrence of bladder tumors.Based on this,the recurrence risk score model of NMIBC patients has certain clinical application value.