title: Nomograms predicting response to therapy and outcomes after bladder-preserving trimodality therapy for muscle-invasive bladder cancer.
abstract: OBJECTIVE
  Selective bladder preservation by use of trimodality therapy is an established management strategy for muscle-invasive bladder cancer. Individual disease features have been associated with response to therapy, likelihood of bladder preservation, and disease-free survival. We developed prognostic nomograms to predict the complete response rate, disease-specific survival, and likelihood of remaining free of recurrent bladder cancer or cystectomy.
  
  
  METHODS
  From 1986 to 2009, 325 patients were managed with selective bladder preservation at Massachusetts General Hospital (MGH) and had complete data adequate for nomogram development. Treatment consisted of a transurethral resection of bladder tumor followed by split-course chemoradiation. Patients with a complete response at midtreatment cystoscopic assessment completed radiation, whereas those with a lesser response underwent a prompt cystectomy. Prognostic nomograms were constructed predicting complete response (CR), disease-specific survival (DSS), and bladder-intact disease-free survival (BI-DFS). BI-DFS was defined as the absence of local invasive or regional recurrence, distant metastasis, bladder cancer-related death, or radical cystectomy.
  
  
  RESULTS
  The final nomograms included information on clinical T stage, presence of hydronephrosis, whether a visibly complete transurethral resection of bladder tumor was performed, age, sex, and tumor grade. The predictive accuracy of these nomograms was assessed. For complete response, the area under the receiving operating characteristic curve was 0.69. The Harrell concordance index was 0.61 for both DSS and BI-DFS.
  
  
  CONCLUSIONS
  Our nomograms allow individualized estimates of complete response, DSS, and BI-DFS. They may assist patients and clinicians making important treatment decisions.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA. jcoen@harthosp.org
authors.forename: John J
authors.initials: JJ
authors.lastname: Coen
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Paly
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Donald S
authors.initials: DS
authors.lastname: Kaufman
authors.forename: Niall M
authors.initials: NM
authors.lastname: Heney
authors.forename: Daphne Y
authors.initials: DY
authors.lastname: Spiegel
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
authors.forename: William U
authors.initials: WU
authors.lastname: Shipley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D059248:Chemoradiotherapy / Q000379:methods; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049451:Nomograms; D059351:Organ Sparing Treatments / Q000379:methods* / Q000401:mortality; D011182:Postoperative Care / Q000379:methods; D016896:Treatment Outcome; D001743:Urinary Bladder; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*