Prognostic factors for metastatic urothelial carcinoma treated with cisplatin and 5-fluorouracil-based regimens.
OBJECTIVE
We have previously shown that a combination of infusion cisplatin and high-dose 5-fluorouracil/leucovorin (P-HDFL) has moderate activity and acceptable toxicity in patients with metastatic urothelial carcinoma. The present study sought to identify factors that predict for patient survival after treatment with P-HDFL-based regimens.


METHODS
The outcomes of 79 patients (median age 69 years) with metastatic urothelial cancer treated in two Phase II trials, including P-HDFL and paclitaxel plus P-HDFL, were updated. The log-rank test and multivariate Cox proportional hazard models were used to identify the prognostic factors predicting for survival.


RESULTS
The median follow-up duration was 38.9 months (range 10.2 to 89.0). A Karnofsky performance status scale of less than 80% (hazard ratio 2.6, 95% confidence interval 1.5 to 4.6), presence of visceral metastasis (hazard ratio 2.3, 95% confidence interval 1.3 to 4.1), and alkaline phosphatase level of 220 U/L or greater (hazard ratio 2.5, 95% confidence interval 1.3 to 4.5) were three significant risk factors predicting for poor survival in the Cox proportional hazard model. The three factors weighted approximately the same and were independent of each other. The median survival for patients with three, one or two, and no risk factors was 4.6, 13.2, and greater than 81.8 months, respectively (P <0.001).


CONCLUSIONS
The Karnofsky performance status scale, presence of visceral metastasis, and alkaline phosphatase level were independent risk factors for survival in patients with metastatic urothelial carcinoma treated with cisplatin and 5-fluorouracil-based regimens.
Lin
Chia-Chi
CC
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Hsu
Chih-Hung
CH
Huang
Chao-Yuan
CY
Tsai
Yu-Chieh
YC
Huang
Kuo-How
KH
Cheng
Ann-Lii
AL
Pu
Yeong-Shiau
YS
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D017567:Karnofsky Performance Status; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D014516:Ureteral Neoplasms / Q000188:drug therapy / Q000473:pathology; D014523:Urethral Neoplasms / Q000188:drug therapy / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology; D014571:Urologic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium
D000970:Antineoplastic Agents; D000469:Alkaline Phosphatase; D002945:Cisplatin; D005472:Fluorouracil