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).

Andrea Necchi 1, * Guru Sonpavde 2 Salvatore Lo Vullo 1 Daniele Giardiello 1 Aristotelis Bamias 3 Simon Crabb 4 Lauren C Harshman 5 Joaquim Bellmunt 5 Ugo De Giorgi 6 Cora N Sternberg 7 Linda Cerbone 7 Sylvain Ladoire 8 Yu-Ning Yu 9 Evan Y Yu 10 Simon Chowdhury 11 Gunter Niegisch 12 Sandy Srinivas 13 Ulka N Vaishampayan 14 Sumanta K Pal 15 Neeraj Agarwal 16 Ajjai Alva 17 Jack Baniel 18 Ali-Reza Golshayan 19 Rafael Morales-Barrera 20 Daniel W Bowles Matthew I Milowsky Christine Theodore 21 Dominik R Berthold Gedske Daugaard 22 Srikala S Sridhar Thomas Powles 23 Jonathan E Rosenberg 24 Matthew D Galsky 25 Luigi Mariani 1
Abstract : BACKGROUND: 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. OBJECTIVE: To develop a new model based on real-world patients. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTION: First-line, platinum-based, combination chemotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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). CONCLUSIONS: We developed and validated two nomograms for OS to be used before and after completion of first-line chemotherapy for metastatic UC. PATIENT SUMMARY: 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. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Contributeur : Lnc - Université de Bourgogne <>
Soumis le : mardi 4 juillet 2017 - 16:49:20
Dernière modification le : lundi 17 septembre 2018 - 17:17:39

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Andrea Necchi, Guru Sonpavde, Salvatore Lo Vullo, Daniele Giardiello, Aristotelis Bamias, et al.. 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).. European Urology, Elsevier, 2017, 71 (2), pp.281-289. 〈http://www.sciencedirect.com/science/article/pii/S0302283816306820〉. 〈10.1016/j.eururo.2016.09.042〉. 〈hal-01556096〉

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