Development of a nomogram incorporating serum C-reactive protein level to predict overall survival of patients with advanced urothelial carcinoma and its evaluation by decision curve analysis.
BACKGROUND
The purpose of this study is to investigate the prognostic impact of C-reactive protein (CRP) on patients with advanced urothelial carcinoma and to develop a novel nomogram predicting survival.


METHODS
A total of 223 consecutive patients were treated at Tokyo Medical and Dental Hospital. A nomogram incorporating V was developed based on the result of a Cox proportional hazards model. Its efficacy and clinical usefulness was evaluated by concordance index (c-index) and decision curve analysis.


RESULTS
Of the 223 patients, 184 (83%) died of cancer. Median follow-up periods of patients who died and those who remained alive were 5 and 11 months, respectively. We developed a novel nomogram incorporating Eastern Cooperative Oncology Group Performance Status, presence of visceral metastasis, haemoglobin and age. The c-index of the nomogram predicting survival probability 6 and 12 months after diagnosis was 0.788 and 0.765, respectively. Decision curve analyses revealed that the novel nomogram incorporating CRP had a superior net benefit than that without CRP for most of the examined probabilities.


CONCLUSIONS
We demonstrated the prognostic impact of CRP that improved the predictive accuracy of a nomogram for survival probability in patients with advanced urothelial carcinoma.
Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8510, Japan.
J
J
Ishioka
K
K
Saito
M
M
Sakura
M
M
Yokoyama
Y
Y
Matsuoka
N
N
Numao
F
F
Koga
H
H
Masuda
Y
Y
Fujii
S
S
Kawakami
K
K
Kihara
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D002295:Carcinoma, Transitional Cell / Q000097:blood*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D001749:Urinary Bladder Neoplasms / Q000097:blood; D014571:Urologic Neoplasms / Q000097:blood*
D002097:C-Reactive Protein