title: Nomogram for predicting survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy.
abstract: BACKGROUND
  The current study was conducted to develop a pretreatment prognostic model for patients with unresectable and/or metastatic urothelial cancer who were treated with first-line, cisplatin-based chemotherapy.
  
  
  METHODS
  Individual data were pooled from 399 patients who were enrolled on 8 phase 2 and 3 trials evaluating cisplatin-based, first-line chemotherapy in patients with metastatic urothelial carcinoma. Variables selected for inclusion in the model were combined in a Cox proportional hazards model to produce a points-based nomogram with which to predict the median, 1-year, 2-year, and 5-year survival. The nomogram was validated externally using data from a randomized trial of the combination of methotrexate, vinblastine, doxorubicin plus cisplatin versus docetaxel plus cisplatin.
  
  
  RESULTS
  The median survival of the development cohort was 13.8 months (95% confidence interval, 12.1 months-16.0 months); 68.2% of the patients had died at the time of last follow-up. On multivariable analysis, the number of visceral metastatic sites, Eastern Cooperative Oncology Group performance status, and leukocyte count were each found to be associated with overall survival (P < .05), whereas the site of the primary tumor and the presence of lymph node metastases were not. All 5 variables were included in the nomogram. When subjected to internal validation, the nomogram achieved a bootstrap-corrected concordance index of 0.626. When applied to the external validation cohort, the nomogram achieved a concordance index of 0.634. Calibration plots suggested that the nomogram was well calibrated for all predictions.
  
  
  CONCLUSIONS
  Based on routinely measured pretreatment variables, a nomogram was constructed that predicts survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. This model may be useful in patient counseling and clinical trial design.
authors.affiliation: Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA. matthew.galsky@mssm.edu
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.forename: Susan
authors.initials: S
authors.lastname: Krege
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Noah
authors.initials: N
authors.lastname: Hahn
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ecke
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: James
authors.initials: J
authors.lastname: Godbold
authors.forename: William K
authors.initials: WK
authors.lastname: Oh
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009362:Neoplasm Metastasis; D049451:Nomograms; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D002945:Cisplatin
keywords: bladder cancer; chemotherapy; cisplatin; metastatic; prognosis; urothelial cancer