Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan.
To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population.



A total of 228 patients with metastatic urothelial carcinoma undergoing systemic chemotherapy between 2000 and 2013 were included in the present multi-institutional study. The gemcitabine plus cisplatin regimen was administered as first-line chemotherapy to 131 patients, whereas methotrexate, vinblastine, doxorubicin, and cisplatin or its modified regimen was given to 71 patients. Of the 228 patients, 119 received at least 2 different regimens and 22 underwent resection of metastases (metastasectomy). Multivariate survival analysis was performed using the Cox proportional hazards model. The characteristics included were age, sex, Eastern Cooperative Oncology Group performance status (PS), primary site, pathology of primary site, hemoglobin levels, lactate dehydrogenase levels, C-reactive protein levels, corrected calcium levels, estimated glomerular filtration rate levels, history of prior chemotherapy, metastatic sites, resection of primary site, number of metastatic organs, and metastasectomy.



The median overall survival (OS) time was 17 months. On multivariate analysis, female sex, good Eastern Cooperative Oncology Group PS at presentation, hemoglobin level≥10g/dl, and single organ metastasis were significant independent predictors of prolonged OS. For the survival effect of metastasectomy, the median OS time of the 22 patients with metastasectomy was 53 months, which was significantly longer when compared with patients not undergoing metastasectomy (15mo). After adjustment for the 4 aforementioned prognostic factors, metastasectomy still remained significant (hazard ratio: 0.364, P = 0.0008).



Female sex, more favorable PS at presentation, hemoglobin level>10g/dl, and single organ metastasis were favorable prognostic factors. In addition, metastasectomy was associated with long-term disease control.
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: takataka@rf6.so-net.ne.jp.
Takashige
T
Abe
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Junji
J
Ishizaki
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Hiroshi
H
Kikuchi
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Keita
K
Minami
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Ryuji
R
Matsumoto
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Toru
T
Harabayashi
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Ataru
A
Sazawa
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Tango
T
Mochizuki
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Satoshi
S
Chiba
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Tomoshige
T
Akino
Hokkaido Urothelial Cancer Research Group, Sapporo, Japan.
Masashi
M
Murakumo
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Naoto
N
Miyajima
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Kunihiko
K
Tsuchiya
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Satoru
S
Maruyama
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Sachiyo
S
Murai
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Nobuo
N
Shinohara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D059146:Metastasectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology
Metastasectomy; Metastatic urothelial carcinoma; Systemic chemotherapy