Heterogeneity and risk prediction study of self-reported outcomes in patients with abdominal wall stoma for bladder cancer based on latent profile analysis and machine learning algorithms

Abstract Abdominal wall stomas in bladder cancer patients can severely impact physical, psychological, and social adjustment. However, individual differences in patients' self-reported outcomes and their influencing factors require further investigation. This multicenter, cross-sectional study aimed to assess the health status of patients with bladder cancer and abdominal wall stomas, identify heterogeneous characteristics among individuals, and screen for risk factors affecting their quality of life. We evaluated 598 patients who underwent radical cystectomy with an abdominal wall stoma between September 2020 and September 2023 in the urology departments of five tertiary hospitals across Henan and Jiangxi Provinces, China. Data were collected via a self-designed general profile questionnaire and the Chinese Patient Self-Reported Outcome Scale for Bladder Cancer with Abdominal Wall Stoma (PROS-BCAS). Latent profile analysis identified three patient subgroups: "balanced high quality" (n = 339, 56.7%), "unbalanced" (n = 148, 24.7%), and "low level" (n = 111, 18.6%). Significant differences were observed in the scores of the four PROS-BCAS domains among these categories (p < 0.05). The factors associated with the "low-level" group included age (45–60 years), low income (monthly per capita <$2,000), self-payment for healthcare, total lack of self-care ability, and the presence of comorbidities. The XGBoost machine learning model identified key factors affecting patient prognosis, such as monthly per capita income, age, healthcare payment method, stoma care status, and comorbidities, in descending order of importance. These findings emphasize the significant individual heterogeneity in self-reported outcomes among bladder cancer patients with abdominal wall stomas. Clinical caregivers should therefore assess and tailor interventions to improve quality of life, particularly for the vulnerable subgroups identified in this study.