Salah Samer, Lee Jae-Lyun, Rozzi Antonio, Kitamura Hiroshi, Matsumoto Kazumasa, Vis Daniel J, Srinivas Sandy, Morales-Barrera Rafael, Carles Joan, Al-Rimawi Dalia, Lee Soonil, Kim Ki Hong, Izumi Kouji, Lewin Jeremy
Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.
Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Clin Genitourin Cancer. 2017 Aug;15(4):e563-e571. doi: 10.1016/j.clgc.2016.12.014. Epub 2016 Dec 22.
Older patients with metastatic urothelial carcinoma (UC) are under-represented in clinical trials, and data regarding outcomes for second-line therapy is limited.
Individual data for patients with metastatic UC, aged ≥ 70 years, were pooled from 10 second-line studies. The influence of potential prognostic factors on overall survival (OS) was assessed via univariate and multivariate Cox regression analysis.
In total, 102 patients were included; the median age was 74.0 years (range, 70-88 years). Second-line chemotherapy was single-agent in 42 (41%) patients and combination regimens in 60 (59%) patients. Median progression-free and OS were 4.3 and 9.7 months, respectively. In multivariate analysis, age > 75 years, Eastern Cooperative Oncology Group performance status ≥ 1, serum hemoglobin < 10 g/dL, and non-lymph node only metastasis predicted inferior OS. Median OS for patients with 0, 1, 2, and ≥ 3 adverse factors was unreached, 15.5, 9.8, and 4.8 months, respectively (P < .001). There was no difference in OS between patients treated with single-agent or combination chemotherapy. Combination regimens were associated with higher occurrences of any ≥ grade 2 toxicity (80% vs. 38%; P < .001), ≥ grade 2 hematologic (78% vs. 12%; P < .001), and ≥ grade 2 gastrointestinal toxicity (36% vs. 7%; P < .001).
In this pooled analysis of older patients with metastatic UC, combination chemotherapy for second-line treatment was associated with greater toxicity without improvement in OS. Eastern Cooperative Oncology Group performance status ≥1, serum hemoglobin < 10 g/dL, and age > 75 years predicted worse survival, whereas isolated lymph node metastasis predicted a favorable outcome.
转移性尿路上皮癌（UC）老年患者在临床试验中的代表性不足，关于二线治疗结局的数据有限。
从10项二线研究中汇总年龄≥70岁的转移性UC患者的个体数据。通过单因素和多因素Cox回归分析评估潜在预后因素对总生存期（OS）的影响。
共纳入102例患者；中位年龄为74.0岁（范围70 - 88岁）。42例（41%）患者接受单药二线化疗，60例（59%）患者接受联合方案化疗。中位无进展生存期和总生存期分别为4.3个月和9.7个月。多因素分析显示，年龄>75岁、东部肿瘤协作组（Eastern Cooperative Oncology Group）体能状态≥1、血清血红蛋白<10 g/dL以及仅非淋巴结转移提示总生存期较差。具有0、1、2和≥3个不良因素的患者的中位总生存期分别为未达到、15.5个月、9.8个月和4.8个月（P<0.001）。接受单药或联合化疗的患者总生存期无差异。联合方案与任何≥2级毒性（80%对38%；P<0.001）、≥2级血液学毒性（78%对12%；P<0.001）以及≥2级胃肠道毒性（36%对7%；P<0.001）的更高发生率相关。
在这项对老年转移性UC患者的汇总分析中，二线治疗的联合化疗毒性更大，总生存期未改善。东部肿瘤协作组体能状态≥1、血清血红蛋白<10 g/dL以及年龄>75岁提示生存较差，而孤立淋巴结转移提示预后良好。
