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Pre-first-line chemotherapy risk stratification for overall survival in advanced urothelial carcinoma in sequential therapy era

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Data availability

The data that support the findings of this study are available from the corresponding author, [KH], upon reasonable request.

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Acknowledgements

This project was made possible with help of the data collected in the Sapporo Medical University Urologic Oncology Consortium (SUOC).

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology, Sapporo Medical University School of Medicine, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan

    Tetsuya Shindo, Kohei Hashimoto, Keiko Fujino, Ko Kobayashi, Toshiaki Tanaka & Naoya Masumori

  2. Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan

    Atsushi Takahashi

  3. Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan

    Hiroshi Hotta

  4. Department of Urology, Oji General Hospital, Tomakomai, Japan

    Toshihiro Maeda

  5. Department of Urology, Sunagawa City Medical Center, Sunagawa, Japan

    Yasuharu Kunishima

  6. Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan

    Fumimasa Fukuta

  7. Department of Urology, NTT East Medical Center Sapporo, Sapporo, Japan

    Naoki Ito

  8. Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan

    Atsushi Wanifuchi

  9. Department of Urology, Muroran City General Hospital, Muroran, Japan

    Ryuichi Kato

  10. Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan

    Manabu Okada

  11. Department of Urology, Takikawa Municipal Hospital, Takikawa, Japan

    Masanori Matsukawa

  12. Department of Urology, Saiseikai Otaru Hospital, Otaru, Japan

    Hiroki Horita

  13. Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan

    Akio Takayanagi

Authors
  1. Tetsuya Shindo
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  2. Kohei Hashimoto
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  18. Naoya Masumori
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Contributions

Protocol/project development: TS, KH, KK, TT, NM. Data collection or management: TS, AT, HH, TM, YK, FF, NI, AW, RK, MO, MM, HH, AT. Data analysis: TS, NM, KF. Manuscript writing/editing: TS, KH, NM.

Corresponding author

Correspondence to Kohei Hashimoto.

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All other authors have nothing to declare.

Ethical approval

The study was performed in accordance with the Declaration of Helsinki and was approved by the institutional review board (Institutional Review Board number 332-300).

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Shindo, T., Hashimoto, K., Fujino, K. et al. Pre-first-line chemotherapy risk stratification for overall survival in advanced urothelial carcinoma in sequential therapy era. World J Urol 42, 307 (2024). https://doi.org/10.1007/s00345-024-04952-z

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  • DOI: https://doi.org/10.1007/s00345-024-04952-z

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