title: Validation of major prognostic models for metastatic urothelial carcinoma using a multi-institutional cohort of the real world.
abstract: BACKGROUND
  Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials.
  
  
  METHODS
  We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis.
  
  
  RESULTS
  Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93).
  
  
  CONCLUSIONS
  All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Taguchi
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. tohru-tky@umin.ac.jp.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Central Coordinating Unit, Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagase
authors.affiliation: Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Taketo
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Sachi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Enomoto
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Yorito
authors.initials: Y
authors.lastname: Nose
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008962:Models, Theoretical; D009362:Neoplasm Metastasis; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000473:pathology*
keywords: Advanced; Bladder cancer; Metastatic; Urothelial carcinoma; Validation