To explore pre-treatment risk factors for overall survival (OS) in advanced urothelial carcinoma (UC) patients treated with first-line (1L) chemotherapy in sequential therapy (ST) era. Additionally, to evaluate the proportion of patients who were not able to undergo subsequent immune checkpoint inhibitor (ICI) therapy according to the subgroups stratified by the risk factors.
A multicenter retrospective study was conducted. Metastatic or locally advanced UC patients treated between 2017 and 2022 were included. The Kaplan-Meier method with the log-rank test and multivariate Cox regression models were used to address OS.
Three hundred and fourteen patients treated with 1L chemotherapy were included in the study and 57 (18.2%) patients were not able to proceed to subsequent ICI therapy. Pre-chemotherapy risk factors for OS in 314 patients were ECOG-PS 1 or more, having no primary site resection, C-reactive protein (CRP) level of 3 mg/dL or more, and non-cisplatin-based regimen. Patients having 3 or 4 risk factors had higher risk for not being able to receive ST (Mann-Whitney U test, P < 0.001). As risk factors for OS in 230 patients who were able to receive ST, having no primary site resection, a neutrophil to lymphocyte ratio of 3 or more, and the presence of liver metastasis were identified.
We reported the risk factors for OS in advanced UC patients treated with 1L chemotherapy in ST era. Patients with high risk for OS may not be able to proceed to subsequent ICI therapy even in the ST era.
World journal of urology. 2024 May 09*** epublish ***
Tetsuya Shindo, Kohei Hashimoto, Keiko Fujino, Atsushi Takahashi, Hiroshi Hotta, Toshihiro Maeda, Yasuharu Kunishima, Fumimasa Fukuta, Naoki Ito, Atsushi Wanifuchi, Ryuichi Kato, Manabu Okada, Masanori Matsukawa, Hiroki Horita, Akio Takayanagi, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori
Department of Urology, Sapporo Medical University School of Medicine, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan., Department of Urology, Sapporo Medical University School of Medicine, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan. ., Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan., Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan., Department of Urology, Oji General Hospital, Tomakomai, Japan., Department of Urology, Sunagawa City Medical Center, Sunagawa, Japan., Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan., Department of Urology, NTT East Medical Center Sapporo, Sapporo, Japan., Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan., Department of Urology, Muroran City General Hospital, Muroran, Japan., Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan., Department of Urology, Takikawa Municipal Hospital, Takikawa, Japan., Department of Urology, Saiseikai Otaru Hospital, Otaru, Japan., Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan.