School of Medicine, University of Washington School of Medicine, Seattle, WA.
Department of Urology, University of Washington Medical Center, Seattle, WA.
Clin Genitourin Cancer. 2021 Apr;19(2):125-134. doi: 10.1016/j.clgc.2020.10.006. Epub 2020 Nov 12.
Optimal chemotherapy for patients who received cisplatin for localized urothelial carcinoma (UC) and develop metastatic disease is unclear. We compared the efficacy of platinum-based (PBC) versus non-platinum-based (NPBC) first-line chemotherapy for metastasis.
Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3024 patients from 28 international academic centers from 2005 to 2012. Patient inclusion criteria included: (1) predominant UC; (2) any primary tumor site; (3) cT2-4, cN0-N2, cM0; (4) prior receipt of perioperative/radiation cisplatin-containing chemotherapy; and (5) receipt of cytotoxic chemotherapy in the first-line metastatic setting. Multivariate Cox proportional hazards models were used to show progression-free survival (PFS) and overall survival (OS) from the first day of chemotherapy for metastatic disease to date of censor.
Eligibility criteria was met by 132 patients (n = 74 PBC; n = 58 NPBC). The median OS was 8.13 months (interquartile range, 4.87-16.64 months) and 8.77 months (interquartile range, 4.01-13.49 months) for PBC and NPBC, respectively. Neither OS (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.64-1.69; P = .87) nor PFS (HR, 0.86; 95% CI, 0.56-1.31; P = .48) differed for PBC versus NPBC. However, for patients who received chemotherapy more than a year after perioperative/radiation chemotherapy, OS was superior for PBC over NPBC (HR, 0.31; 95% CI, 0.10-0.92; P = .03).
There is no significant outcome difference between PBC and NPBC in patients with metastatic UC who previously received cisplatin-based chemotherapy for localized disease. However, if over a year has elapsed, return to PBC is associated with superior OS.
对于接受顺铂治疗局限性尿路上皮癌（UC）并发展为转移性疾病的患者，最佳化疗方案尚不明确。我们比较了铂类（PBC）与非铂类（NPBC）一线化疗治疗转移的疗效。
数据来自 2005 年至 2012 年间 28 个国际学术中心的 3024 例患者的回顾性国际尿路上皮癌研究（RISC）数据库。患者纳入标准包括：（1）主要为 UC；（2）任何原发肿瘤部位；（3）cT2-4、cN0-N2、cM0；（4）接受过围手术期/放疗含顺铂化疗；（5）在转移性一线治疗中接受细胞毒性化疗。多变量 Cox 比例风险模型用于显示自转移性疾病开始化疗的第一天到截止日期的无进展生存期（PFS）和总生存期（OS）。
符合条件的患者有 132 例（n=74 例 PBC；n=58 例 NPBC）。PBC 和 NPBC 的中位 OS 分别为 8.13 个月（四分位间距，4.87-16.64 个月）和 8.77 个月（四分位间距，4.01-13.49 个月）。PBC 与 NPBC 的 OS（风险比[HR]，1.04；95%置信区间[CI]，0.64-1.69；P=0.87）和 PFS（HR，0.86；95%CI，0.56-1.31；P=0.48）均无差异。然而，对于在围手术期/放疗化疗后 1 年以上接受化疗的患者，PBC 的 OS 优于 NPBC（HR，0.31；95%CI，0.10-0.92；P=0.03）。
对于先前接受顺铂治疗局限性疾病的转移性 UC 患者，PBC 与 NPBC 之间的治疗结果无显著差异。然而，如果已经过去了 1 年以上，回归 PBC 与更好的 OS 相关。
