Predictive factors for response and prognostic factors for long-term survival in consecutive, single institution patients with locally advanced and/or metastatic transitional cell carcinoma following cisplatin-based chemotherapy

Figures & data

Table I.  Chemotherapy regimes 1991–2001.

Trial	No. of patients
Cisplatin 100 mg/m^2, carboplatin 200 mg/m^2, methotrexate 250 mg/m^2 (phase II) [15]	24
Cisplatin 100 mg/m^2, methotrexate 30 mg/m^2, mitoxantrone 10 mg/m^2 (phase II) [16]	14
Gemcitabine 1000 mg/m^2, cisplatin 35 mg/m^2 (phase II) [17]	18
Gemcitabine 1000 mg/m^2, cisplatin 70 mg/m^2 vs.	43
Methotrexate 30 mg/m^2, vinblastine 3 mg/m^2, doxorubicin 30 mg/m^2, cisplatin 70 mg/m^2 (phase III) [18]
Gemcitabine 1000 mg/m^2, cisplatin 70 mg/m^2, paclitaxel 175 mg/m^2 (phase II) [19]	12
Methotrexate 30 mg/m^2, vinblastine 3 mg/m^2, doxorubicin 30 mg/m^2, cisplatin 70 mg/m^2 (standard)	44
Gemcitabine 1000 mg/m^2, cisplatin 70 mg/m^2 (standard)	23
Total	178

Seven chemotherapy regimes used to treat a total of 178 patients with transitional cell carcinoma at our institution between 1991–2001.

Table II.  Prognostic factors for survival (univariate analyses)

	N	Median survival (months)	P	CR+PR (%)	NC+PD (%)	P
All patients	178	12.10		57 (46%)	68 (54%)
Performance status
≤ 1	140	14.80	0.000	50 (53%)	45 (47%)
≥ 2	38	5.23		7 (23%)	23 (77%)	0.005
B-haemoglobin
♂≥8,4; ♀≥7,4 mmol/l	82	15.43	0.001	31 (53%)	27 (47%)
♂<8,4; ♀<7,4 mmol/l	96	10.30		26 (39%)	41 (61%)	0.101
S-creatinine
≤ 120 µmol/l	155	12.43	0.336	52 (46%)	60 (54%)
> 120 µmol/l	23	11.73		5 (38%)	8 (62%)	0.585
GFR (1)
≥ 60 ml/min	161	13.07	0.027	53 (47%)	60 (53%)
< 60 ml/min	16	9.57		4 (33%)	8 (66%)	0.370
S-ALAT (1)
≤ 40 U/l	161	12.70	0.318	54 (47%)	60 (53%)
> 40 U/l	16	8.60		3 (30%)	7 (70%)	0.291
S-LDH (1)
≤ 500 U/l	152	13.13	0.000	51 (50%)	50 (50%)
> 500 U/l	25	7.63		6 (26%)	17 (74%)	0.034
S-alkaline phosphatase (1)
≤ 270 U/l	119	13.53	0.001	40 (52%)	37 (48%)
> 270 U/l	58	8.57		17 (36%)	30 (64%)	0.087
Lung metastasis (1)
No	143	13.13	0.037	47 (50%)	48 (50%)
Yes	34	7.90		10 (34%)	19 (66%)	0.156
Liver metastasis (9)
No	135	14.93	0.000	46 (51%)	44 (49%)
Yes	34	7.80		9 (32%)	19 (68%)	0.079
Bone metastasis
No	145	13.23	0.001	49 (50%)	49 (50%)
Yes	33	7.63		8 (30%)	19 (70%)	0.060
Visceral metastasis (2)
No	89	18.03	0.000	33 (65%)	18 (35%)
Yes	87	8.47		24 (33%)	48 (67%)	0.001
Histology (1)
Pure TTC	149	12.70	0.517	46 (44%)	59 (56%)
TTC with squamous or adenomatous differentiation	28	11.27		11 (58%)	8 (42%)	0.257
Grade of primary tumour (2)
≤ 3	129	12.07	0.689	44 (47%)	50 (53%)
4	47	12.70		13 (42%)	18 (58%)	0.637

Patient characteristics and the results of the univariate analyses concerning the pre-treatment prognostic factors for survival and predictive factors for response. The numbers in brackets (.) in the first column represent number of missing values. Abbreviations: CR, complete response, PR, partial response, NC, no change, PD, progressive disease, TCC, transitional cell carcinoma.

Table III.  Predictive factors for response (multivariate analysis)

Variables	P	Odds ratio	95% CI
Performance status	0.084	2.567	0.882–7.471
LDH	0.187	2.185	0.685–6.975
AP	0.582	1.303	0.508–3.343
Visceral metastasis	0.039	2.835	1.054–7.625

Results of binary logistic regression analysis including 117 patients evaluable for response. Eight patients were excluded because of missing values. Abbreviations: CI, confidence interval.

Table IV.  Prognostic factors for survival (multivariate analysis)

Variables	P	Odds ratio	95% CI
Performance status	0.001	2.194	1.408–3.420
B-haemoglobin	0.110	1.352	0.934–1.956
GFR	0.281	1.375	0.771–2.454
S-LDH	0.226	1.386	0.817–2.352
S-alkaline phosphatase	0.691	1.088	0.718–1.647
Visceral metastasis	0.001	2.779	1.526–5.060

Results of Cox multivariate regression analysis including 167 patients. Eleven patients were excluded because of missing values. Abbreviations: CI, confidence interval.

Table V.  Risk factors influence on survival

No. of prognostic factors	N(%)	Median survival	P
0	48(27%)	18.03
1	95(54%)	13.23	< 0.0001
2	33(19%)	5.23

The influence of numbers of adverse prognostic factors (risk factors) on survival.

Table VI.  Risk factors influence on response

No. of prognostic factors	N	CR+PR(%)	NC+PD(%)	P
0	19	12(63%)	7(37%)
1	76	40(53%)	36(47%)	0.002
2	28	5(18%)	23(82%)

The influence of numbers of adverse prognostic factors (risk factors) on response.Abbreviations: CR, complete response, PR, partial response.

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