Development and Internal Validation of the BRICS Score: A Preoperative Clinical and Hematological Model for Predicting High-Grade and Muscle-Invasive Bladder Cancer
- 1Department of Urology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- 2Department of Urology, Târgu Mureș Clinical Hospital, P-ța Bernády György, Nr. 6, 540072 Târgu-Mureș, Romania
- 3Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
Abstract
Background/Objectives: We developed and internally validated the Bladder Risk Index using Clinical and Systemic biomarkers (BRICS), a preoperative prediction model designed to estimate the likelihood of high-grade (HG) disease and muscle-invasive bladder cancer (MIBC) in patients undergoing their first transurethral resection of bladder tumor (TURBT). Methods: This retrospective single-center study included 161 patients with newly diagnosed urothelial bladder cancer. The BRICS-HG model included tumor size, neutrophil-to-lymphocyte ratio (NLR), and creatinine-to-hemoglobin ratio (CHR), while the BRICS-MIBC model was based on tumor size and NLR. Model performance was assessed in terms of discrimination, calibration, and Brier score, together with exploratory decision curve analysis. Internal validation was performed using 2000 bootstrap resamples. Results: MIBC was identified in 20 patients (12.4%). BRICS-HG demonstrated limited discriminatory ability, with an apparent AUC of 0.649 and an optimism-corrected AUC of 0.623 (95% bootstrap interval: 0.541–0.703). BRICS-MIBC achieved moderate discrimination, with an apparent AUC of 0.735 and an optimism-corrected AUC of 0.709 (95% bootstrap interval: 0.588–0.826). Across the bootstrap resamples, the model combining tumor size and NLR was selected in 53.9% of cases, reflecting uncertainty in predictor selection. Conclusions: BRICS-HG should be regarded as an exploratory model, and its current performance does not support clinical application. BRICS-MIBC demonstrated moderate discrimination after internal validation; however, its performance should be interpreted cautiously given the small number of MIBC events. Validation in larger, independent cohorts, ideally across multiple centers, is necessary before the model can be considered for clinical implementation.
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BibTeX
@article{gherasim2026development,
title = {{Development and Internal Validation of the BRICS Score: A Preoperative Clinical and Hematological Model for Predicting High-Grade and Muscle-Invasive Bladder Cancer}},
author = {Raul-Dumitru Gherasim and Daniel Porav-Hodade and Călin Chibelean and Septimiu Voidazan and Ciprian Todea-Moga and Oliver-Arpad Vida and Veronica-Maria Ghirca and Rareș-Florin Vascul and Tibor Lorand Reman and Orsolya Katalin Ilona Martha},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203282},
url = {https://www.mdpi.com/2072-6694/18/20/3282},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Development and Internal Validation of the BRICS Score: A Preoperative Clinical and Hematological Model for Predicting High-Grade and Muscle-Invasive Bladder Cancer
AU - Raul-Dumitru Gherasim
AU - Daniel Porav-Hodade
AU - Călin Chibelean
AU - Septimiu Voidazan
AU - Ciprian Todea-Moga
AU - Oliver-Arpad Vida
AU - Veronica-Maria Ghirca
AU - Rareș-Florin Vascul
AU - Tibor Lorand Reman
AU - Orsolya Katalin Ilona Martha
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203282
UR - https://www.mdpi.com/2072-6694/18/20/3282
AB - Background/Objectives: We developed and internally validated the Bladder Risk Index using Clinical and Systemic biomarkers (BRICS), a preoperative prediction model designed to estimate the likelihood of high-grade (HG) disease and muscle-invasive bladder cancer (MIBC) in patients undergoing their first transurethral resection of bladder tumor (TURBT). Methods: This retrospective single-center study included 161 patients with newly diagnosed urothelial bladder cancer. The BRICS-HG model included tumor size, neutrophil-to-lymphocyte ratio (NLR), and creatinine-to-hemoglobin ratio (CHR), while the BRICS-MIBC model was based on tumor size and NLR. Model performance was assessed in terms of discrimination, calibration, and Brier score, together with exploratory decision curve analysis. Internal validation was performed using 2000 bootstrap resamples. Results: MIBC was identified in 20 patients (12.4%). BRICS-HG demonstrated limited discriminatory ability, with an apparent AUC of 0.649 and an optimism-corrected AUC of 0.623 (95% bootstrap interval: 0.541–0.703). BRICS-MIBC achieved moderate discrimination, with an apparent AUC of 0.735 and an optimism-corrected AUC of 0.709 (95% bootstrap interval: 0.588–0.826). Across the bootstrap resamples, the model combining tumor size and NLR was selected in 53.9% of cases, reflecting uncertainty in predictor selection. Conclusions: BRICS-HG should be regarded as an exploratory model, and its current performance does not support clinical application. BRICS-MIBC demonstrated moderate discrimination after internal validation; however, its performance should be interpreted cautiously given the small number of MIBC events. Validation in larger, independent cohorts, ideally across multiple centers, is necessary before the model can be considered for clinical implementation.
SN - 2072-6694
ER -