Despite increasing use of neoadjuvant treatment, the prognosis for patients with high-risk muscle-invasive urothelial carcinoma (MIUC) remains poor, data from a recent real-world study suggest.

From 2001 to 2013, the use of neoadjuvant treatment overall increased from 12% to 46% and use of cisplatin-based neoadjuvant chemotherapy increased from 5% to 38%. Still, median overall survival (OS) and disease-free survival (DFS) were 23.1 and 13.5 months, respectively. These findings were reported by a team led by Alexandra Drakaki, MD, PhD, of the University of California Los Angeles in California, in Urologic Oncology.

The most significant predictor of poor prognosis for both outcomes was American Joint Commission on Cancer (AJCC) stage 3B/4A disease, followed by non-White race and Charlson Comorbidity Index (CCI) of 2 or higher.

The study, which used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, included 665 patients with high-risk MIUC who underwent surgical resection from 2001 to 2013. Patients had a mean age of 75.5 years, 61% were men, and 91% were white.


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Patients with stage 3A and 3B/4A disease had 40% and 87% shorter OS times, respectively, compared with patients who had stage 2 disease. Patients with a CCI of 2 or higher had a 59% shorter OS time than those with a CCI lower than 2. In addition, non-White patients had a 50% shorter OS compared with White patients.

With regard to DFS, patients with AJCC stage 3A or stage 3B/4A had 18% and 77% shorter DFS times, respectively, compared with patients who had stage 2 disease. Patients with a CCI of 2 or higher had a 55% shorter DFS time than those with a CCI less than 2. Non-White patients had a 51% shorter DFS compared with White patients.

“Patients with high-risk MIUC continue to have a high risk of mortality within 2 years of extirpative surgery despite increasing use of cisplatin-based chemotherapy,” the authors concluded. “Unmet treatment needs persist for this difficult-to-treat patient population and support the evaluation of new, safe, and effective adjuvant therapeutic approaches in clinical trials, as well as biomarker exploration.”

Disclosure: The study was sponsored by F. Hoffmann-La Roche, Ltd. Please refer to the reference for a complete list of authors’ disclosures.

Reference

Drakaki A, Pantuck A, Mhatre SK, et al. “Real-world” outcomes and prognostic indicators among patients with high-risk muscle-invasive urothelial carcinoma. Urol Oncol. Published online August 8, 2020. doi:10.1016/j.urolonc.2020.07.011