Alqaisi Husam A, Stecca Carlos, Veitch Zachary W, Riromar Jamila, Kaiser Jeenan, Fallah-Rad Nazanin, Jiang Di Maria, North Scott, Samnani Sunil, Alimohamed Nimira, Sridhar Srikala S
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Division of Medical Oncology and Hematology, St. Michael's Hospital, Toronto, ON, Canada.
Ther Adv Med Oncol. 2022 May 1;14:17588359221094879. doi: 10.1177/17588359221094879. eCollection 2022.
In metastatic urothelial cancer (mUC), bone metastasis (BM) are associated with significant morbidity and mortality, yet their role as an independent prognostic variable remains unclear. We aimed to determine the impact of BM on overall survival (OS) in patients with mUC treated with first-line platinum-based chemotherapy (PBC).
mUC patients receiving PBC at the Princess Margaret Cancer Center, Tom Baker Cancer Center, or Cross Cancer Institute from January 2005 to January 2018 were identified retrospectively using central pharmacy database records. Patient disease, treatment, and response characteristics were collected. Progression-free survival (PFS) and OS were estimated using the Kaplan-Meier method. Variables reaching significance ( < 0.05) in univariable analysis (UVA) of survival (OS) were included in multivariable analysis (MVA) (Cox).
Overall, 376 patients with a median follow-up of 16.8 (range: 2.2-218.3) months were included. Median age was 67 (range: 28-91) years, 76% were male, 63% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1, and 41% had BM. All patients received first-line PBC. Patients with BM had inferior median PFS (4.9 months (95% CI 3.6-6.2) 6.5 months (95% CI 5.4-7.6), = 0.03) and median OS (8.8 months (95% CI 7.8-9.7) 10.8 months (95% CI 9.1-12.5), = 0.002). In UVA, ECOG PS 2-3 ( < 0.001), presence of BM ( = 0.002), and WBC count ⩾ 11,000 cells/mm ( = 0.001) were associated with inferior survival. Prior cystectomy ( < 0.001) and lack of progression (stable disease, partial or complete response) on treatment was associated with improved OS ( < 0.001). These variables maintained significance in MVA.
In this retrospective study, mUC patients with BM had worse OS suggesting that BM may be an independent negative prognostic factor and including BM as a stratification factor in future mUC clinical trial designs may be warranted. A greater focus must be placed on novel therapeutic strategies to better manage BM to reduce both morbidity and mortality.
在转移性尿路上皮癌（mUC）中，骨转移（BM）与显著的发病率和死亡率相关，但其作为独立预后变量的作用仍不明确。我们旨在确定BM对接受一线铂类化疗（PBC）的mUC患者总生存期（OS）的影响。
回顾性利用中心药房数据库记录，确定2005年1月至2018年1月在玛格丽特公主癌症中心、汤姆·贝克癌症中心或十字癌症研究所接受PBC的mUC患者。收集患者的疾病、治疗和反应特征。采用Kaplan-Meier法估计无进展生存期（PFS）和OS。生存（OS）单变量分析（UVA）中具有显著性（P<0.05）的变量纳入多变量分析（MVA）（Cox模型）。
总体纳入376例患者，中位随访时间为16.8（范围：2.2 - 218.3）个月。中位年龄为67（范围：28 - 91）岁，76%为男性，63%的东部肿瘤协作组体能状态（ECOG PS）为0 - 1，41%有BM。所有患者均接受一线PBC。有BM的患者中位PFS较差（4.9个月（95%CI 3.6 - 6.2）对6.5个月（95%CI 5.4 - 7.6），P = 0.03），中位OS也较差（8.8个月（95%CI 7.8 - 9.7）对10.8个月（95%CI 9.1 - 12.5），P = 0.002）。在UVA中，ECOG PS 2 - 3（P<0.001）、存在BM（P = 0.002）和白细胞计数⩾11,000个细胞/mm³（P = 0.001）与较差的生存期相关。既往膀胱切除术（P<0.001）和治疗无进展（疾病稳定、部分或完全缓解）与OS改善相关（P<0.001）。这些变量在MVA中仍具有显著性。
在这项回顾性研究中，有BM的mUC患者OS较差，提示BM可能是一个独立的不良预后因素，在未来mUC临床试验设计中纳入BM作为分层因素可能是必要的。必须更加关注新的治疗策略，以更好地管理BM，降低发病率和死亡率。
