Bamias Aristotle, Peroukidis Stavros, Stamatopoulou Sophia, Tzannis Kimon, Koutsoukos Konstantinos, Andreadis Charalambos, Bozionelou Vasiliki, Pistalmatzian Nikos, Papatsoris Athanasios, Stravodimos Konstantinos, Varthalitis Ioannis, Karamouzis Michalis, Milaki Georgia, Agorastos Antonios, Kentepozidis Nikos, Androulakis Nikos, Bompolaki Iliada, Kalofonos Haralampos, Mavroudis Dimitrios, Dimopoulos Meletios A
Department of Clinical Therapeutics, University of Athens, Athens, Greece.
Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece.
Clin Genitourin Cancer. 2016 Apr;14(2):e153-9. doi: 10.1016/j.clgc.2015.09.009. Epub 2015 Sep 25.
Advanced urothelial cancer (AUCa) is associated with poor long-term survival. Two major concerns are related to nonexposure to cisplatin-based chemotherapy and poor outcome after relapse. Our purpose was to record patterns of practice in AUCa in Greece, focusing on first-line treatment and management of relapsed disease.
Patients with AUCa treated from 2011 to 2013 were included in the analysis. Fitness for cisplatin was assessed by recently established criteria.
Of 327 patients treated with first-line chemotherapy, 179 (55%) did not receive cisplatin. Criteria for unfitness for cisplatin were: Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, 21%; creatinine clearance ≤ 60 mL/min, 55%; hearing impairment, 8%; neuropathy, 1%; and cardiac failure, 5%. Forty-six patients (27%) did not fulfill any criterion for unfitness for cisplatin. The main reasons for these deviations were comorbidities (28%) and advanced age (32%). Seventy-four (68%) of 109 patients who experienced a relapse received second-line chemotherapy. The most frequent reason for not offering second-line chemotherapy was poor PS or limited life expectancy (66%).
In line with international data, approximately 50% of Greek patients with AUCa do not receive cisplatin-based chemotherapy, although 27% of them were suitable for such treatment. In addition, about one third of patients with relapse did not receive second-line chemotherapy because of poor PS or short life expectancy. Enforcing criteria for fitness for cisplatin and earlier diagnosis of relapse represent 2 targets for improvement in current treatment practice for AUCa.
晚期尿路上皮癌（AUCa）的长期生存率较低。两个主要问题与未接受基于顺铂的化疗以及复发后的不良预后有关。我们的目的是记录希腊AUCa的治疗模式，重点关注一线治疗和复发性疾病的管理。
纳入2011年至2013年接受治疗的AUCa患者进行分析。根据最近制定的标准评估顺铂的适用性。
在327例接受一线化疗的患者中，179例（55%）未接受顺铂治疗。不适合使用顺铂的标准为：东部肿瘤协作组（ECOG）体能状态（PS）≥2，占21%；肌酐清除率≤60 mL/分钟，占55%；听力障碍，占8%；神经病变，占1%；心力衰竭，占5%。46例（27%）患者不符合任何不适合使用顺铂的标准。这些偏差的主要原因是合并症（28%）和高龄（32%）。109例复发患者中有74例（68%）接受了二线化疗。不提供二线化疗的最常见原因是PS差或预期寿命有限（66%）。
与国际数据一致，约50%的希腊AUCa患者未接受基于顺铂的化疗，尽管其中27%的患者适合这种治疗。此外，约三分之一的复发患者因PS差或预期寿命短而未接受二线化疗。强化顺铂适用性标准和更早诊断复发是当前AUCa治疗实践中有待改进的两个目标。
