title: A nomogram predicting the cancer-specific mortality in patients eligible for radical cystectomy evaluating clinical data and neoadjuvant cisplatinum-based chemotherapy.
abstract: OBJECTIVE
  Despite the increasing number of studies confirming the importance of neoadjuvant chemotherapy (NC) in patients before radical cystectomy (RC) for bladder cancer (BCa), NC remains underused. The aim of our study was to develop a nomogram predicting the cancer-specific mortality (CSM) of patients who underwent RC for transitional BCa, evaluating the available clinical information and the NC.
  
  
  METHODS
  We identified 423 patients who underwent RC and pelvic lymph node dissection, treated or not with NC, in two European high-volume centers between 2007 and 2013. Chi-square and Student's t tests were used to evaluate differences between groups. Kaplan-Meier curves were used to assess time to cancer-specific (CSS) and overall survival (OS). Uni- (UVA) and multivariable (MVA) Cox regression analyses were developed to address predictors of CSS and OS. A nomogram based on the Cox regression coefficient was developed to show the impact of NC on CSM.
  
  
  RESULTS
  Mean follow-up was 20.3 months. Our population had mainly pT2 disease (77.1%), and 19.4% had preoperative cisplatinum-based NC. NC showed better CSS at UVA (p = 0.014) and MVA (odds ratio: 0.44; p = 0.043). Overall, the 3-year OS and the CSS rate were 69.3 and 79%, respectively. The nomogram developed to predict the 36-month CSM showed predictive accuracy of 67%.
  
  
  CONCLUSIONS
  We developed the first nomogram predicting the 36-month CSM rate in patients with high-risk BCa according to the clinical data. Moreover, we demonstrate that preoperative cisplatinum-based chemotherapy is associated with better CSS.
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.|Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Ettore
authors.initials: E
authors.lastname: Di Trapani
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France. rafaelsanchezsalas.imm@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rocchini
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Daphne
authors.initials: D
authors.lastname: Lizee
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Arie
authors.initials: A
authors.lastname: Carneiro
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sivaraman
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.affiliation: Department of Medical Oncology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Mostefa
authors.initials: M
authors.lastname: Bennamoun
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D020360:Neoadjuvant Therapy; D049451:Nomograms; D016017:Odds Ratio; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
chemical_list: D002945:Cisplatin
keywords: Bladder cancer; Neoadjuvant chemotherapy; Nomogram; Radical cystectomy