Platinum-based chemotherapy in urinary bladder cancer – 10 years clinical experiences
DOI: 10.22591/magyurol.2019.2.modoso.58
Authors:
Módos Orsolya dr.1, Bozsaki Ákos1, Nagy Cintia1, Nagy Nikolett1, Csizmarik Anita1, Keresztes Dávid1, Oláh Csilla1, Váradi Melinda1, Horváth András dr.1, Szendrői Attila dr.1, Szűcs Miklós dr.1, Keszthelyi Attila dr.1, Nyirády Péter dr.1, Szarvas Tibor dr.1,2
1Semmelweis Egyetem ÁOK, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.);
2Duisburg-Esseni Egyetem, Urológiai Klinika, Essen
Summary
Objective: Cisplatin-based chemotherapy is the first-line treatment for locally advanced and metastatic bladder cancer. Novel checkpoint inhibitor therapies are approaching and are currently approved for second-line treatment. In this retrospective study, we report our 10-years single institution experiences with cisplatin-based chemotherapy.
Patients and methods: We collected clinicopathological and follow-up data of bladder cancer patients treated with platinum-based chemotherapy in our clinic between 2007 and 2017. Correlations between clinicopathological and follow-up data have been evaluated and compared to those published in the literature.
Results: Our internal database search identified 135 bladder cancer patients with sufficient data who received cisplatin-based chemotherapy. Of these patients 97 were men (72%) and 38 were women (28%). At the time of diagnosis, the median age was 63 years (40-82 years). We grouped patients based on the indication of chemotherapy: 1) Adjuvant chemotherapy was performed in patients with locally advanced (pT3/T4, N0; n=42/135; 31.1%) and/or with lymph node metastatic cases (pT1/T2, N+, n=19/135; 14.1% or pT3/pT4 and N+, n=28/135; 20,7%). 2) Induction chemotherapy was performed in those patients who had tumor progression after surgical treatment (local recurrence n=5/135; 3.7%, distant organ metastases n=7/135; 5.2% and distant lymph node metastases n=1/135; 0.8%). 3) Patients who were unfit for radical cystectomy received palliative chemotherapy (n=33/135; 24.4%).
Patients who received induction chemotherapy had the most unfavourable survival (p<0.001). In the induction chemotherapy group patients with lymph node metastasis had a significant better prognosis compared to those with local recurrence or distant metastasis (p=0.036). Diabetes mellitus proved to be a significant risk factor for patients’ survival (p=0.027). Patients who showed a radiographic response to chemotherapy had a significant better survival (p=0.047).
Conclusions: Our analysis demonstrated that the indication of chemotherapy, the progression site and diabetes mellitus have a significant impact on survival of platinum-treated bladder cancer patients. Therapy predictive models for cisplatin-based chemotherapy implementing molecular features of bladder cancer are needed to improve therapeutic decision making.