Prognostic model for predicting survival of patients with metastatic urothelial cancer treated with cisplatin-based chemotherapy

• Published in: JNCI : Journal of the National Cancer Institute 2013-04, Vol.105 (7), p.499-503
• Main Authors: Apolo, Andrea B, Ostrovnaya, Irina, Halabi, Susan, Iasonos, Alexia, Philips, George K, Rosenberg, Jonathan E, Riches, Jamie, Small, Eric J, Milowsky, Matthew I, Bajorin, Dean F
• Format: Article
• Language: English
• Subjects: Aged; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brief Communication; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - mortality; Chemotherapy; Cisplatin - administration & dosage; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Doxorubicin - administration & dosage; Female; Gemcitabine; Humans; Ifosfamide - administration & dosage; Kidney Neoplasms - drug therapy; Kidney Neoplasms - mortality; Male; Medical prognosis; Metastasis; Middle Aged; Nomograms; Paclitaxel - administration & dosage; Platinum; Predictive Value of Tests; Prognosis; Survival Analysis; Treatment Outcome; Urothelium - pathology
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djt015

A prognostic model that predicts overall survival (OS) for metastatic urothelial cancer (MetUC) patients treated with cisplatin-based chemotherapy was developed, validated, and compared with a commonly used Memorial Sloan-Kettering Cancer Center (MSKCC) risk-score model. Data from 7 protocols that enrolled 308 patients with MetUC were pooled. An external multi-institutional dataset was used to validate the model. The primary measurement of predictive discrimination was Harrell's c-index, computed with 95% confidence interval (CI). The final model included four pretreatment variables to predict OS: visceral metastases, albumin, performance status, and hemoglobin. The Harrell's c-index was 0.67 for the four-variable model and 0.64 for the MSKCC risk-score model, with a prediction improvement for OS (the U statistic and its standard deviation were used to calculate the two-sided P = .002). In the validation cohort, the c-indices for the four-variable and the MSKCC risk-score models were 0.63 (95% CI = 0.56 to 0.69) and 0.58 (95% CI = 0.52 to 0.65), respectively, with superiority of the four-variable model compared with the MSKCC risk-score model for OS (the U statistic and its standard deviation were used to calculate the two-sided P = .02).