順鉑（Cisplatin）適用條件對於晚期泌尿上皮癌病患之治療與存活影響

曾聖修、游智欽、蔡曜州

臺北慈濟醫院，外科部，泌尿科

Different treatment patterns and survival outcomes based on Cisplatin eligibility in patients with advanced urothelial carcinoma receiving first-line systemic therapy  

Shen-Shiou Tseng、Chih-Chin Yu、Yao-Chou Tsai

Divisions of Urology, Department of Surgery, Taipei Tzu Chi Hospital, New Taipei, Taiwan

Purpose: This study investigated real-world differences in management and outcome of patients with locally advanced or metastatic urothelial carcinoma receiving first-line systemic therapy based on Cisplatin eligibility

Materials and Methods: This is a retrospective observational study with data extracted from the nationwide Taiwan Upper Tract Urothelial Cancer and Taiwan Urological Association Collaborative Research Organization Database. 250 Eligible adults (aged 18 years and older) diagnosed between January 1, 2017 and December 31, 2022 with advanced or metastatic urothelial carcinoma without previous neoadjuvant/adjuvant therapy were included.

Definition of Platinum ineligibility was that patients had Eastern Cooperative Oncology Group performance status at least 3, creatinine clearance less than 30mL/min, or Eastern Cooperative Oncology Group performance status of 2 and creatinine clearance less than 60mL/min. Categorical patient characteristics were compared with Chi-square test and continuous variables were evaluated with Mann–Whitney U test. Overall survival (OS), Cancer specific survival (CSS) and progression-free survival (PFS) were summarized using the Kaplan–Meier method.

Results: Among all 250 patients, 181 (72.4%) were considered platinum eligible and 61 (27.6%) patients were platinum ineligible. Median overall survival was significantly longer in platinum-eligible group (13.65 vs 9.9 months in platinum-ineligible patients). Median PFS in platinum-ineligible was 3.29 months and in platinum-eligible patients was 6.17 months. However, no significance was observed.

Conclusions: This study showed the real-world treatment regimen and outcomes received by platinum ineligible patients diagnosed with locally advanced or metastatic urothelial carcinoma. Still over 60% of these patients has received chemotherapy although they are often excluded in trials.   These findings highlight the need of more attention and further study of therapy options.