Beas-Lozano Evelyn Lilian, Remolina-Bonilla Yuly A, Caballero Rosa, Sobrevilla-Moreno Nora, Perez-Perez Perla, Díaz-Alvarado Maria Guadalupe, Zayas-Villanueva Omar Alejandro, Martinez-Castañeda Erika Adriana, Campos-Gomez Saul, Cardoso-Aparicio Luis Arturo, Mendoza-Oliva Dolores, Bourlon Maria T
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Instituto Nacional de Cancerologia, Mexico City, Mexico.
JCO Glob Oncol. 2025 Jan;11:e2400431. doi: 10.1200/GO-24-00431. Epub 2025 Jan 2.
Metastatic urothelial carcinoma (mUC) poses a challenge to health care systems, given its treatment complexity and mortality. We aimed to describe the characteristics, treatment patterns, and survival outcomes of Mexican patients with mUC.
A retrospective study was conducted across eight centers for adults with mUC from January /2001 to December 2021. We recorded medical history, eligibility for first-line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used and survival analysis, including Kaplan-Meier curves and Cox proportional hazards model, was performed.
We identified 379 patients with mUC; 37 were excluded, and 76% was male, with a median age of 67 years. The median follow-up was 8.4 months. Among those who received a first-line treatment (65%), cisplatin-based chemotherapy (45%) was the most common followed by carboplatin (39%). Causes of cisplatin ineligibility were Eastern Cooperative Oncology Group ≥2 (41%) and glomerular filtration rate <60 mL/min (33%). The overall response rate to up-front platinum therapy was 33%, with a median progression-free survival of 6.1 months (95% CI, 4.9 to 6.9). Second-, third-, and fourth-line treatment was given to 24.6%, 8.8%, and 3.5%, respectively. Chemotherapy was the most common regimen prescribed. Access to novel drugs was limited, 14 patients received avelumab, and 25% received immunotherapy as second-line treatment. The median overall survival was 11.8 months (95% CI, 10.2 to 15.2). Multivariate analysis showed that first-line treatment was independently associated with better survival, whereas poor performance status and visceral disease were associated with worse survival.
To our knowledge, these data represent the first effort to delineate treatment trends of mUC in Mexico. First-line treatment prescription and rates of progression to platinum therapy were higher than those described worldwide. Factors affecting survival included performance status, first-line treatment, and visceral disease. Our study highlights unequal access to novel treatments, underscoring the need for equitable care.
转移性尿路上皮癌（mUC）因其治疗复杂性和死亡率，给医疗保健系统带来了挑战。我们旨在描述墨西哥mUC患者的特征、治疗模式和生存结果。
对2001年1月至2021年12月期间八个中心的成年mUC患者进行了一项回顾性研究。我们记录了病史、一线铂类治疗的 eligibility、接受的治疗线数以及获得新药的情况。使用描述性统计方法，并进行了生存分析，包括Kaplan-Meier曲线和Cox比例风险模型。
我们确定了379例mUC患者；排除37例，76%为男性，中位年龄为67岁。中位随访时间为8.4个月。在接受一线治疗的患者中（65%），以顺铂为基础的化疗（45%）最为常见，其次是卡铂（39%）。顺铂不适用的原因是东部肿瘤协作组状态≥2（41%）和肾小球滤过率<60 mL/分钟（33%）。 upfront铂类治疗的总体缓解率为33%，中位无进展生存期为6.1个月（95%CI，4.9至6.9）。二线、三线和四线治疗分别给予24.6%、8.8%和3.5%的患者。化疗是最常用的方案。获得新药的机会有限，14例患者接受了阿维鲁单抗治疗，25%的患者接受了免疫治疗作为二线治疗。中位总生存期为11.8个月（95%CI，10.2至15.2）。多变量分析表明，一线治疗与更好的生存独立相关，而较差的体能状态和内脏疾病与较差的生存相关。
据我们所知，这些数据是首次描述墨西哥mUC治疗趋势的努力。一线治疗处方和铂类治疗的进展率高于全球报道的水平。影响生存的因素包括体能状态、一线治疗和内脏疾病。我们的研究强调了获得新治疗方法的不平等，凸显了公平医疗的必要性。
