Cheeseman Sue, Thompson Matthew, Sopwith Will, Godden Paul, Seshagiri Divyagiri, Adedokun Lola, Zucker Kieran, Jain Sunjay, Kotwal Sanjeev, Prescott Stephen, Henry Ann, Joseph Joji, Chilka Sameer, Roulson Jo-An, Weston Michael, Burbidge Simon, Brown Simon, Jagdev Satinder, Ralph Christy, Hall Geoff, Vasudev Naveen S
Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom.
IQVIA, London, United Kingdom.
Front Oncol. 2020 Feb 20;10:167. doi: 10.3389/fonc.2020.00167. eCollection 2020.
To characterize treatment patterns and survival outcomes for patients with locally advanced or metastatic malignancy of the urothelial tract during a period immediately preceding the widespread use of immune checkpoint inhibitors in the UK. We retrospectively examined the electronic case notes of patients attending the Leeds Cancer Center, UK with locally advanced or metastatic urothelial carcinoma, receiving chemotherapy between January 2003 and March 2017. Patient characteristics, treatment patterns, and outcomes were collected. Summary and descriptive statistics were calculated for categorical and continuous variables as appropriate. The Kaplan-Meier method was used to estimate median survival and Cox regression proportional hazards model was used to explore relationships between clinical variables and outcome. Two hundred and sixteen patients made up the study cohort, with a median age of 66 years (range: 35-83) and 72.7% being male. First-line treatment consisted of either a cisplatin- (44%) or carboplatin-based regimen (48%) in the majority of patients. Twenty seven percent of patients received a second-line of treatment (most commonly single-agent paclitaxel) following a first-line platinum containing regimen. Grade 4 neutropenia was observed in 19 and 27% of those treated with a first-line cisplatin- and carboplatin-based regimen, respectively. The median overall survival (mOS) of the study cohort was estimated to be 16.2 months (IQR: 10.6-28.3 months). Receipt by patients of cisplatin-based chemotherapy was associated with a longer mOS and this association persisted when survival analysis was adjusted for age, sex, performance status and presence of distant metastases. This study provides a useful benchmark for outcomes achieved in a real-world setting for patients with locally advanced or metastatic UC treated with chemotherapy in the immediate pre-immunotherapy era.
为了描述在英国广泛使用免疫检查点抑制剂之前的一段时间内，局部晚期或转移性尿路上皮恶性肿瘤患者的治疗模式和生存结果。我们回顾性研究了2003年1月至2017年3月期间在英国利兹癌症中心就诊的局部晚期或转移性尿路上皮癌患者的电子病历，这些患者接受了化疗。收集了患者的特征、治疗模式和结果。对分类变量和连续变量进行了适当的汇总和描述性统计。采用Kaplan-Meier方法估计中位生存期，采用Cox回归比例风险模型探讨临床变量与结果之间的关系。该研究队列由216名患者组成，中位年龄为66岁（范围：35-83岁），男性占72.7%。大多数患者的一线治疗方案为含顺铂（44%）或卡铂（48%）的方案。27%的患者在一线含铂方案治疗后接受了二线治疗（最常见的是单药紫杉醇）。在接受一线顺铂和卡铂方案治疗的患者中，分别有19%和27%观察到4级中性粒细胞减少。该研究队列的中位总生存期（mOS）估计为16.2个月（四分位间距：10.6-28.3个月）。患者接受基于顺铂的化疗与更长的mOS相关，当生存分析针对年龄、性别、体能状态和远处转移的存在进行调整时，这种关联仍然存在。这项研究为免疫治疗前时代接受化疗的局部晚期或转移性UC患者在现实世界中的治疗结果提供了一个有用的基准。
