Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Ann Oncol. 2018 Feb 1;29(2):361-369. doi: 10.1093/annonc/mdx692.
Cisplatin-based combination chemotherapy is the standard treatment of advanced urinary tract cancer (aUTC), but 50% of patients are ineligible for cisplatin according to recently published criteria. We used a multinational database to study patterns of chemotherapy utilization in patients with aUTC and determine their impact on survival.
This was a retrospective study of patients with: UTC (bladder, renal pelvis, ureter or urethra); advanced disease (stages T4b and/or N+ and/or M+); urothelial, squamous or adenocarcinoma histology. Primary objective was overall survival (OS). Eligibility-for-cisplatin was defined by Eastern Cooperative Oncology Group performance status ≤ 1, creatinine clearance ≥ 60 ml/min, no hearing loss, no neuropathy and no heart failure. Cox regression multivariate analyses were used to establish independent associations of cisplatin versus noncisplatin-based chemotherapy on OS.
1794 patients treated between 2000 and 2013 at 29 centers were analyzed. Median follow-up was 29.1 months. About 1333 patients (74%) received first-line chemotherapy: the use of first-line chemotherapy was associated with longer OS: [hazard ratio (HR): 1.91, 95% confidence interval (CI): 1.67-2.20]. Type of first-line chemotherapy received was: cisplatin-based 669 (50%), carboplatin-based 399 (30%) and other 265 (20%). Cisplatin use was an independent favorable prognostic factor (HR: 1.54, 95% CI: 1.35-1.77). This benefit was independent of baseline characteristics or comorbidities but was associated with eligibility-for-cisplatin: eligible patients treated with cisplatin lived longer than those who were not (HR: 1.74, 95% CI: 1.36-2.21), while such benefit was not observed among ineligible patients. About 26% of patients who did not receive cisplatin were eligible for this agent. Median OS of ineligible patients was poor irrespective of the chemotherapy used.
The importance of applying published criteria of eligibility-for-cisplatin was confirmed in a multinational, real-world setting in aUTC. The reasons for deviations from these criteria set targets to improve adherence. Effective therapies for cisplatin-ineligible patients are needed.
顺铂为基础的联合化疗是晚期尿路上皮癌（aUTC）的标准治疗方法，但根据最近发表的标准，有 50%的患者不符合顺铂治疗条件。我们使用一个多国家数据库研究了 aUTC 患者化疗使用的模式，并确定了其对生存的影响。
这是一项对患有：尿路上皮癌（膀胱、肾盂、输尿管或尿道）；晚期疾病（T4b 期和/或 N+期和/或 M+期）；尿路上皮、鳞状或腺癌组织学的患者进行的回顾性研究。主要终点是总生存期（OS）。顺铂治疗的资格标准由东部肿瘤协作组（ECOG）表现状态评分≤1、肌酐清除率≥60ml/min、无听力损失、无周围神经病变和无心力衰竭定义。使用 Cox 回归多变量分析确定顺铂与非顺铂为基础的化疗对 OS 的独立关联。
在 29 个中心对 2000 年至 2013 年期间治疗的 1794 名患者进行了分析。中位随访时间为 29.1 个月。约 1333 名患者（74%）接受了一线化疗：使用一线化疗与更长的 OS 相关：[风险比（HR）：1.91，95%置信区间（CI）：1.67-2.20]。接受的一线化疗类型为：顺铂为基础的化疗 669 例（50%），卡铂为基础的化疗 399 例（30%），其他化疗 265 例（20%）。顺铂的使用是一个独立的有利预后因素（HR：1.54，95% CI：1.35-1.77）。这种益处独立于基线特征或合并症，但与顺铂治疗的资格有关：符合条件的接受顺铂治疗的患者比不符合条件的患者存活时间更长（HR：1.74，95% CI：1.36-2.21），而不符合条件的患者则没有观察到这种益处。约 26%的未接受顺铂治疗的患者符合该药物的治疗条件。不符合条件的患者无论使用何种化疗，中位 OS 均较差。
在 aUTC 的多国家、真实世界环境中，应用顺铂治疗资格标准的重要性得到了证实。偏离这些标准的原因确定了提高依从性的目标。需要为不符合顺铂治疗条件的患者提供有效的治疗方法。
