title: Nomogram-based Prediction of Overall Survival in Patients with Metastatic Urothelial Carcinoma Receiving First-line Platinum-based Chemotherapy: Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC).
abstract: The available prognostic models for overall survival (OS) in patients with metastatic urothelial carcinoma (UC) have been derived from clinical trial populations of cisplatin-treated patients.
  
  
  
  To develop a new model based on real-world patients.
  
  
  
  Individual patient-level data from 29 centers were collected, including metastatic UC and first-line cisplatin- or carboplatin-based chemotherapy administered between January 2006 and January 2011.
  
  
  
  First-line, platinum-based, combination chemotherapy.
  
  
  
  The population was randomly split into a development and a validation cohort. Generalized boosted regression modelling was used to screen out irrelevant variables and address multivariable analyses. Two nomograms were built to estimate OS probability, the first based on baseline factors and platinum agent, the second incorporating objective response (OR). The performance of the above nomograms and that of other available models was assessed. We plotted decision curves to evaluate the clinical usefulness of the two nomograms.
  
  
  
  A total of 1020 patients were analyzed (development: 687, validation: 333). In a platinum-stratified Cox model, significant variables for OS were performance status (p<0.001), white blood cell count (p=0.013), body mass index (p=0.003), ethnicity (p=0.012), lung, liver, or bone metastases (p<0.001), and prior perioperative chemotherapy (p=0.012). The c-index was 0.660. The distribution of the nomogram scores was associated with OR (p<0.001), and incorporating OR into the model further improved the c-index in the validation cohort (0.670).
  
  
  
  We developed and validated two nomograms for OS to be used before and after completion of first-line chemotherapy for metastatic UC.
  
  
  
  We proposed two models for estimating overall survival of patients with metastatic urothelial carcinoma receiving first-line, platinum-based chemotherapy. These nomograms have been developed on real-world patients who were treated outside of clinical trials and may be used irrespective of the chemotherapeutic platinum agent used.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. Electronic address: andrea.necchi@istitutotumori.mi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: UAB Comprehensive Cancer Center, Birmingham, AL, USA.
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lo Vullo
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Giardiello
authors.affiliation: University of Athens, Athens, Greece.
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Bamias
authors.affiliation: University of Southampton, Southampton, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Crabb
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Harshman
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: San Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
authors.affiliation: San Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Cerbone
authors.affiliation: Center Georges-François Leclerc, Dijon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ladoire
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Evan Y
authors.initials: EY
authors.lastname: Yu
authors.affiliation: Guy's and St. Thomas' Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Chowdhury
authors.affiliation: Heinrich-Heine-University, Medical Faculty, Department of Urology, Düsseldorf, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Niegisch
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: Karmanos Cancer Institute, Detroit, MI, USA.
authors.forename: Ulka N
authors.initials: UN
authors.lastname: Vaishampayan
authors.affiliation: City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.affiliation: University of Utah, Salt Lake City, UT, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ajjai
authors.initials: A
authors.lastname: Alva
authors.affiliation: Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Jack
authors.initials: J
authors.lastname: Baniel
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Golshayan
authors.affiliation: Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Morales-Barrera
authors.affiliation: Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Bowles
authors.affiliation: University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
authors.affiliation: Hopital Foch, Suresnes, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Theodore
authors.affiliation: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Dominik R
authors.initials: DR
authors.lastname: Berthold
authors.affiliation: Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Gedske
authors.initials: G
authors.lastname: Daugaard
authors.affiliation: Princess Margaret Hospital, University Health Network, Toronto, Canada.
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar
authors.affiliation: Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Powles
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Rosenberg
authors.affiliation: Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D011897:Random Allocation; D012189:Retrospective Studies; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000556:secondary
chemical_list: D016190:Carboplatin; D002945:Cisplatin
keywords: Nomogram; Overall survival; Platinum chemotherapy; Prognosis; Urothelial carcinoma