Time from Prior Chemotherapy Enhances Prognostic Risk Grouping in the Second-line Setting of Advanced Urothelial Carcinoma: A Retrospective Analysis of Pooled, Prospective Phase 2 Trials

被引：103

作者：

Sonpavde, Guru ^{[1
]}

Pond, Gregory R. ^{[2
,3
]}

Fougeray, Ronan ^{[4
]}

Choueiri, Toni K. ^{[5
,6
]}

Qu, Angela Q. ^{[6
]}

Vaughn, David J. ^{[7
]}

Niegisch, Guenter ^{[8
]}

Albers, Peter ^{[8
]}

James, Nicholas D. ^{[9
]}

Wong, Yu-Ning ^{[10
]}

Ko, Yoo-Joung ^{[11
]}

Sridhar, Srikala S. ^{[12
]}

Galsky, Matthew D. ^{[13
]}

Petrylak, Daniel P. ^{[14
]}

Vaishampayan, Ulka N. ^{[15
]}

Khan, Awais ^{[1
]}

Vogelzang, Nicholas J. ^{[16
]}

Beer, Tomasz M. ^{[17
]}

Stadler, Walter M. ^{[18
]}

O'Donnell, Peter H. ^{[18
]}

Sternberg, Cora N. ^{[19
,20
]}

Rosenberg, Jonathan E. ^{[21
]}

Bellmunt, Joaquim ^{[22
]}

机构：

[1] Univ Alabama Birmingham, Birmingham Comprehens Canc Ctr, Birmingham, AL USA

[2] McMaster Univ, Hamilton, ON, Canada

[3] Ontario Clin Oncol Grp, Hamilton, ON, Canada

[4] Inst Rech Pierre Fabre, Boulogne, France

[5] Dana Farber Canc Inst, Boston, MA 02115 USA

[6] Harvard Univ, Sch Med, Boston, MA USA

[7] Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA

[8] Univ Dusseldorf, D-40225 Dusseldorf, Germany

[9] Univ Birmingham, Birmingham, W Midlands, England

[10] Fox Chase Canc Ctr, Philadelphia, PA 19111 USA

[11] Sunnybrook Odette Canc Ctr, Toronto, ON, Canada

[12] Princess Margaret Hosp, Toronto, ON M4X 1K9, Canada

[13] Mt Sinai Sch Med, Tisch Canc Ctr Inst, New York, NY USA

[14] Yale Canc Ctr, New Haven, CT USA

[15] Wayne State Univ, Karmanos Canc Inst, Detroit, MI USA

[16] Comprehens Canc Ctr Nevada, Las Vegas, NV USA

[17] Oregon Hlth & Sci Univ, Knight Canc Inst, Portland, OR 97201 USA

[18] Univ Chicago, Chicago, IL 60637 USA

[19] San Camillo Hosp, Rome, Italy

[20] Forlanini Hosp, Rome, Italy

[21] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA

[22] Univ Hosp Mar IMIM, Barcelona, Spain

来源：

EUROPEAN UROLOGY | 2013年 / 63卷 / 04期

关键词：

Urothelial carcinoma; Second line; Prognosis; Time from prior chemotherapy; Hemoglobin; Liver metastasis; Performance status; TRANSITIONAL-CELL CARCINOMA; III TRIAL; CANCER; PACLITAXEL; VINFLUNINE; GEMCITABINE; REGIMEN; PLUS;

D O I：

10.1016/j.eururo.2012.11.042

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Outcomes for patients in the second-line setting of advanced urothelial carcinoma (UC) are dismal. The recognized prognostic factors in this context are Eastern Cooperative Oncology Group (ECOG) performance status (PS) >0, hemoglobin level (Hb) <10 g/dl, and liver metastasis (LM). Objectives: The purpose of this retrospective study of prospective trials was to investigate the prognostic value of time from prior chemotherapy (TFPC) independent of known prognostic factors. Design, setting, and participants: Data from patients from seven prospective trials with available baseline TFPC, Hb, PS, and LM values were used for retrospective analysis (n = 570). External validation was conducted in a second-line phase 3 trial comparing best supportive care (BSC) versus vinflunine plus BSC (n = 352). Outcome measurements and statistical analysis: Cox proportional hazards regression was used to evaluate the association of factors, with overall survival (OS) and progression-free survival (PFS) being the respective primary and secondary outcome measures. Results and limitations: ECOG-PS >0, LM, Hb <10 g/dl, and shorter TFPC were significant prognostic factors for OS and PFS on multivariable analysis. Patients with zero, one, two, and three to four factors demonstrated median OS of 12.2, 6.7, 5.1, and 3.0 mo, respectively (concordance statistic = 0.638). Setting of prior chemotherapy (metastatic disease vs perioperative) and prior platinum agent (cisplatin or carboplatin) were not prognostic factors. External validation demonstrated a significant association of TFPC with PFS on univariable and most multivariable analyses, and with OS on univariable analyses. Limitations of retrospective analyses are applicable. Conclusions: Shorter TFPC enhances prognostic classification independent of ECOG-PS >0, Hb <10 g/dl, and LM in the setting of second-line therapy for advanced UC. These data may facilitate drug development and interpretation of trials. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.

引用

页码：717 / 723

页数：7

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