Background Cisplatin-based combination chemotherapy is the standard treatment of advanced urinary tract cancer (aUTC), but 50% of patients are ineligible for cisplatin according to recently published criteria. We used a multinational database to study patterns of chemotherapy utilization in patients with aUTC and determine their impact on survival. Patients and methods This was a retrospective study of patients with: UTC (bladder, renal pelvis, ureter or urethra); advanced disease (stages T4b and/or N+ and/or M+); urothelial, squamous or adenocarcinoma histology. Primary objective was overall survival (OS). Eligibility-for-cisplatin was defined by Eastern Cooperative Oncology Group performance status ≤ 1, creatinine clearance ≥ 60 ml/min, no hearing loss, no neuropathy and no heart failure. Cox regression multivariate analyses were used to establish independent associations of cisplatin versus noncisplatin-based chemotherapy on OS. Results 1794 patients treated between 2000 and 2013 at 29 centers were analyzed. Median follow-up was 29.1 months. About 1333 patients (74%) received first-line chemotherapy: the use of first-line chemotherapy was associated with longer OS: [hazard ratio (HR): 1.91, 95% confidence interval (CI): 1.67-2.20]. Type of first-line chemotherapy received was: cisplatin-based 669 (50%), carboplatin-based 399 (30%) and other 265 (20%). Cisplatin use was an independent favorable prognostic factor (HR: 1.54, 95% CI: 1.35-1.77). This benefit was independent of baseline characteristics or comorbidities but was associated with eligibility-for-cisplatin: eligible patients treated with cisplatin lived longer than those who were not (HR: 1.74, 95% CI: 1.36-2.21), while such benefit was not observed among ineligible patients. About 26% of patients who did not receive cisplatin were eligible for this agent. Median OS of ineligible patients was poor irrespective of the chemotherapy used. Conclusions The importance of applying published criteria of eligibility-for-cisplatin was confirmed in a multinational, real-world setting in aUTC. The reasons for deviations from these criteria set targets to improve adherence. Effective therapies for cisplatin-ineligible patients are needed.

中文翻译：

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当代化疗使用模式对晚期泌尿道癌患者生存率的影响：一项关于侵袭性/晚期尿路上皮癌 (RISC) 的国际回顾性研究。

背景 基于顺铂的联合化疗是晚期尿路癌 (aUTC) 的标准治疗方法，但根据最近公布的标准，50% 的患者不适合使用顺铂。我们使用一个跨国数据库来研究 aUTC 患者的化疗使用模式，并确定它们对生存的影响。患者和方法 这是对以下患者的回顾性研究：UTC（膀胱、肾盂、输尿管或尿道）；晚期疾病（T4b 和/或 N+ 和/或 M+ 期）；尿路上皮、鳞状或腺癌的组织学。主要目标是总生存期（OS）。顺铂的合格性定义为东部肿瘤协作组体能状态≤1、肌酐清除率≥60 ml/min、无听力损失、无神经病变和无心力衰竭。Cox 回归多变量分析用于建立顺铂与非顺铂化疗对 OS 的独立关联。结果分析了 2000 年至 2013 年间在 29 个中心接受治疗的 1794 名患者。中位随访时间为 29.1 个月。大约 1333 名患者 (74%) 接受了一线化疗：使用一线化疗与更长的 OS 相关：[风险比 (HR): 1.91, 95% 置信区间 (CI): 1.67-2.20]。接受的一线化疗类型为：基于顺铂的 669 例（50%）、基于卡铂的 399 例（30%）和其他 265 例（20%）。顺铂的使用是一个独立的有利预后因素（HR：1.54，95% CI：1.35-1.77）。这种益处与基线特征或合并症无关，但与顺铂的资格相关：接受顺铂治疗的符合条件的患者比没有接受顺铂治疗的患者活得更长（HR：1.74，95% CI：1.36-2.21），而在不符合条件的患者中未观察到这种益处。约 26% 未接受顺铂治疗的患者有资格使用该药物。无论使用何种化疗，不合格患者的中位 OS 都很差。结论 应用已公布的顺铂资格标准的重要性在 aUTC 的跨国、真实世界环境中得到证实。偏离这些标准的原因设定了提高依从性的目标。需要对不适合顺铂的患者进行有效的治疗。无论使用何种化疗，不合格患者的中位 OS 都很差。结论 应用已公布的顺铂资格标准的重要性在 aUTC 的跨国、真实世界环境中得到证实。偏离这些标准的原因设定了提高依从性的目标。需要对不适合顺铂的患者进行有效的治疗。无论使用何种化疗，不合格患者的中位 OS 都很差。结论 应用已公布的顺铂资格标准的重要性在 aUTC 的跨国、真实世界环境中得到证实。偏离这些标准的原因设定了提高依从性的目标。需要对不适合顺铂的患者进行有效的治疗。