Nomogram for predicting survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy
Article first published online: 29 MAY 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 16, pages 3012–3019, 15 August 2013
How to Cite
Galsky, M. D., Moshier, E., Krege, S., Lin, C.-C., Hahn, N., Ecke, T., Sonpavde, G., Godbold, J., Oh, W. K. and Bamias, A. (2013), Nomogram for predicting survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. Cancer, 119: 3012–3019. doi: 10.1002/cncr.28146
- Issue published online: 2 AUG 2013
- Article first published online: 29 MAY 2013
- Manuscript Revised: 8 DEC 2013
- Manuscript Received: 15 OCT 2013
- Manuscript Accepted: 10 JAN 2013
- urothelial cancer;
- bladder cancer;
The current study was conducted to develop a pretreatment prognostic model for patients with unresectable and/or metastatic urothelial cancer who were treated with first-line, cisplatin-based chemotherapy.
Individual data were pooled from 399 patients who were enrolled on 8 phase 2 and 3 trials evaluating cisplatin-based, first-line chemotherapy in patients with metastatic urothelial carcinoma. Variables selected for inclusion in the model were combined in a Cox proportional hazards model to produce a points-based nomogram with which to predict the median, 1-year, 2-year, and 5-year survival. The nomogram was validated externally using data from a randomized trial of the combination of methotrexate, vinblastine, doxorubicin plus cisplatin versus docetaxel plus cisplatin.
The median survival of the development cohort was 13.8 months (95% confidence interval, 12.1 months-16.0 months); 68.2% of the patients had died at the time of last follow-up. On multivariable analysis, the number of visceral metastatic sites, Eastern Cooperative Oncology Group performance status, and leukocyte count were each found to be associated with overall survival (P < .05), whereas the site of the primary tumor and the presence of lymph node metastases were not. All 5 variables were included in the nomogram. When subjected to internal validation, the nomogram achieved a bootstrap-corrected concordance index of 0.626. When applied to the external validation cohort, the nomogram achieved a concordance index of 0.634. Calibration plots suggested that the nomogram was well calibrated for all predictions.
Based on routinely measured pretreatment variables, a nomogram was constructed that predicts survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. This model may be useful in patient counseling and clinical trial design. Cancer 2013;119:3012—3019. © 2013 American Cancer Society.