Conditional Survival of Patients Treated With First-Line Chemotherapy for Metastatic Urothelial Cancer

The aim of this study was to assess the changes in 2-year conditional survival (CS) rates after first-line chemotherapy for metastatic urothelial cancer (UC) and to determine how well established prognostic factors evolve over time in these patients. Our results showed that patients with hemoglobin (Hb) levels < 12 g/dL had a significantly poorer survival, although this difference tended to disappear over time. In addition, patients with neutrophil to lymphocyte ratio (NLR) < 3 and age < 70 years showed an increase in their conditional overall survival (COS) and conditional progression-free survival (CPFS) over time. In conclusion, the conditional probability of survival at 2 years from the start of first-line chemotherapy for advanced UC changes over time according to clinical characteristics. Background: Measures of prognosis for cancer patients are typically evaluated at the time of diagnosis. However, this study assessed the changes in 2-year CS rates after first-line chemotherapy for metastatic UC. Patients and Methods: Conditional overall survival and CPFS probability were estimated using the Kaplan-Meier method. Adjusted survival functions were stratified according to age groups (< 70 years vs. >= 70 years), sex, Eastern Cooperative Oncology Group (ECOG) performance status (PS; ECOG PS >= 2 vs. ECOG PS > 2), pretreatment Hb levels (< 12 mg/dL vs. >= 12 mg/dL) and pretreatment NLR (< 3 vs. >= 3). Pairs of CS curves were compared using the Mantel -Haenszel log-rank test. Results: Two hundred ninety-eight patients were included in this analysis, 233 were male, and their median age was 69 years. First-line median overall survival and progression-free survival were 10.7 months (95% confidence interval [CI], 9.6-12.6) and 6.0 months (95% CI, 5.5-7.1), respectively. CPFS and COS showed an increasing trend in the population considered (b = 0.35; P < .001 and b = 0.79; P < .001, respectively). A significant increase in terms of COS and CPFS trends was identified in patients with age < 70 years (P = .02 and P = .005, respectively) and pretreatment NLR = 3 (P = .05 and P < .001, respectively). Patients with Hb levels < 12 g/dL showed a significantly poorer 2-year COS. Conclusion: The conditional probability of survival at 2 years from the start of first-line chemotherapy for advanced UC changes over time according to clinical characteristics.