Posttreatment prognostic nomogram for patients with metastatic urothelial cancer completing first-line cisplatin-based chemotherapy.
BACKGROUND
Models to predict the outcome of patients with metastatic urothelial cancer (UC), based on pretreatment variables, have previously been developed. However, patients often request "updated" prognostic estimates based upon their response to treatment.


METHODS
Data were pooled from 317 patients enrolled in 8 trials evaluating first-line cisplatin-based chemotherapy in metastatic UC. Variables were combined in the Cox proportional hazards model to produce a nomogram to predict survival from the end of treatment. The nomogram was validated externally using data from a phase III trial.


RESULTS
The median survival from end of treatment was 10.65 months (95% confidence interval; 9.20-13.24); 69% of patients had died. Baseline and posttreatment variables were evaluated. Baseline performance status, baseline number of visceral metastatic sites, baseline white blood counts, and response to treatment were included in the final model. The nomogram achieved a bootstrap-corrected concordance index of 0.68. Upon external validation, the nomogram achieved a concordance index of 0.67.


CONCLUSIONS
A model derived from pretreatment and posttreatment variables was constructed to predict survival from the completion of first-line chemotherapy in patients with metastatic UC. This model may be useful for patient counseling and for stratification of trials exploring "maintenance" therapy.
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY. Electronic address: matthew.galsky@mssm.edu.
Matthew D
MD
Galsky
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
Erin
E
Moshier
Urologische Klinik, Alexianer Krefeld GmbH, Krefeld, Germany.
Susan
S
Krege
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Chia-Chi
CC
Lin
Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN.
Noah
N
Hahn
HELIOS Hospital, Bad Saarow, Germany.
Thorsten
T
Ecke
US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX; University of Alabama Comprehensive Cancer Center, Birmingham, AL.
Guru
G
Sonpavde
McMaster University, Ontario, Canada.
Gregory
G
Pond
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
James
J
Godbold
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
William K
WK
Oh
University of Athens, Athens, Greece; Hellenic Cooperative Oncology Group, Athens, Greece.
Aristotle
A
Bamias
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology
D002945:Cisplatin
Chemotherapy; Cisplatin; Metastatic; Nomogram; Prognosis; Urothelial cancer