Prognostic Factors for Metastatic Urothelial Carcinoma Undergoing Cisplatin-based Salvage Chemotherapy

Abstract

Objective: To assess the clinicopathologic factors influencing survival in patients with metastatic urothelial carcinoma undergoing salvage chemotherapy. Methods: A retrospective review was conducted on cases of metastatic urothelial carcinoma who underwent cisplatin-based salvage chemotherapy at our institution between April 2003 and July 2011. The association of various clinicopathologic factors with survival was assessed. Survival curves were constructed by the Kaplan -Meier method. A log-rank test for univariate analysis and a Cox proportional hazards model for multivariate analysis were used. Results: Eighty-three cases were identified in the study. Among them, 64 patients were dead during the follow-up. The median survival was 14.6 months. Multivariate analysis evaluating variables at the start of chemotherapy demonstrated that liver metastasis, performance status score 2 and leukocyte counts 8000/ml were significant predictive factors for poor outcome. Based on these three pre-induction variables, a risk model predicting the overall survival from the initiation of chemotherapy was constructed, which classified patients into three groups with significantly different overall survival (P , 0.0001). Additionally, factors after induction of chemotherapy were studied, and poor response for chemotherapy and absence of focal treatment for metastatic lesions were also significantly associated with poorer survival. Conclusions: Liver metastasis, poor performance status and higher leukocyte counts were independent poor prognostic indicators for metastatic urothelial carcinoma. Our risk classification enables an accurate prediction of survival that can be useful in deciding which patients are likely to benefit from salvage chemotherapy.

The comparison of oncologic outcomes between metastatic upper tract urothelial carcinoma and urothelial carcinoma of the bladder after cisplatin-based chemotherapy

“…Previous literatures have shown the survival prediction for metastatic UC after chemotherapy, mainly focusing on UCB [18][19][20][21][22][23][24][25][26]. There were limited studies to separately investigate or compare the prognostic factors between metastatic UTUC and UCB after cisplatin-based chemotherapy.…”

Pretreatment neutrophil‐to‐lymphocyte ratio as an independent predictor of survival in patients with metastatic urothelial carcinoma: A multi‐institutional study

“…We previously reported that higher leukocyte counts, poor performance status and liver metastasis were independent poor prognostic factors for metastatic UC in a Japanese, retrospective, single-institutional study. 3 NLR has recently been shown to be a prognostic factor in many malignancies. 4 Regarding UC, there are several reports of patients with upper urinary tract UC [5][6][7][8][9] and a few in patients with bladder cancer undergoing radical cystectomy.…”

Combination of docetaxel, ifosfamide and cisplatin (DIP) as a potential salvage chemotherapy for metastatic urothelial carcinoma

“…Similarly, von der Maase et al (4) showed that KPS < 80%, the presence of visceral metastasis, elevated alkaline phosphatase and the number of disease sites (>3) were significant prognostic parameters in patients with locally advanced or metastatic UC treated with GC or MVAC. Furthermore, we have recently reported that liver metastasis, poor performance status and higher leukocyte counts were independent poor prognostic factors for metastatic UC (25). On the other hand, studies concerning prognostic factors after failure of first-line salvage treatment are lacking.…”