title: Nomogram for predicting survival of postcystectomy recurrent urothelial carcinoma of the bladder.
abstract: We aimed to identify prognostic clinicopathological factors and to create a nomogram able to predict overall survival (OS) in recurrent urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC).
  
  
  
  Among 1,087 patients with UCB who had undergone RC at our 11 institutions between 1990 and 2010, 306 patients who subsequently developed distant metastasis or local recurrence or both were identified. Clinical data were collected with medical record review. Univariate and multivariate Cox regression models addressed OS after recurrence. A nomogram predicting postrecurrence OS was constructed based on Cox proportional hazards model, without using postrecurrence factors (systemic chemotherapy and resection of metastasis). The performance of the nomogram was internally validated by assessing concordance index and calibration plots.
  
  
  
  Of the 306 patients, 268 died during follow-up with a median survival of 7 months (95% CI: 5.8-8.5). Postrecurrence chemotherapy was administered in 119 patients (38.9%). Multivariable analysis identified 9 independent predictors for OS; period of time from RC to recurrence (time-to-recurrence), symptomatic recurrence, liver metastasis, hemoglobin level, serum alkaline phosphatase level, serum lactate dehydrogenase level, serum C-reactive protein level, postrecurrence chemotherapy, and resection of metastasis. A nomogram was formed with the following 5 variables to predict OS: time-to-recurrence, symptomatic recurrence, liver metastasis, albumin level, and alkaline phosphatase level. Concordance index rate was 0.75 (95% CI: 0.72-0.78) by internal validation using Bootstraps with 1,000 resamples. Calibration plots showed that the nomogram fitted well.
  
  
  
  We identified 9 clinicopathological factors as independent OS predictors in postcystectomy recurrence of UCB. We also created a validated nomogram with 5 variables that efficiently stratified those patients regardless of eligibility for chemotherapy. The nomogram would be useful for acquiring relevant prognostic information and for stratifying patients for clinical trials.
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: tohru-tky@umin.ac.jp.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Taguchi
authors.affiliation: Biostatistics Division, Central Coordinating Unit, 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, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kanatani
authors.affiliation: Department of Urology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan; Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Yoshida
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, National Center for Global Health and Medicine Center Hosptial, Tokyo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Department of Urology, National Center for Global Health and Medicine Center Hosptial, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yamada
authors.affiliation: Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Komemushi
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Enomoto
authors.affiliation: Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.affiliation: Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
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, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kondo
authors.affiliation: Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Urology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Okaneya
authors.affiliation: Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hirano
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Shinohara
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideyo
authors.initials: H
authors.lastname: Miyazaki
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Urology, National Center for Global Health and Medicine Center Hosptial, Tokyo, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Igawa
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D049451:Nomograms; D011379:Prognosis; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Nomogram; Radical cystectomy; Recurrence; Urothelial carcinoma