Reasons for lack of treatment in patients with locally advanced, unresectable or metastatic urothelial carcinoma

Figures & data

Figure 1. Flow diagram depicting the population screened for study enrollment, reasons for exclusion and the final study population.

Table 1. Baseline characteristics of 100 patients diagnosed with mUC at Rigshospitalet, Denmark in the period 1 January 2010 to 31 March 2016, who did not receive systemic anticancer treatment and of 952 patients with locally advanced, unresectable or metastatic urothelial tract cancer of different histologic subtypes who received SAT in Denmark during the same inclusion period.

	Present study (n = 100)	Omland et al. (2021) (n = 952)^18
Gender
Male	66 (66%)	686 (72.1%)
Female	34 (34%)	266 (27.9%)
Median age at diagnosis of mUC, years (IQR)	72 (66-77)	69 (63-75)
Histology
UC^a	100 (100%)	879 (92.3%)
SCC		27 (2.8%)
Adenocarcinoma		10 (1.1%)
SCN carcinoma		29 (3.0%)
Other		5 (0.5%)
Unknown		2 (0.2%)
Primary tumor location
Upper urinary tract	14 (14%)	168 (17.6%)
Bladder	83 (83%)	767 (80.6%)
Urethra	1 (1%)	14 (1.5%)
Unknown	2 (2%)	3 (0.3%)
TNM stage at diagnosis
T4bN0M0	3 (3%)	–
Any T, N+, M0	12 (12%)	–
Any T, Any N, M1	20 (20%)	–
Unknown	65 (65%)	–
Initial presentation with mUC	32 (32%)	–
mUC following recurrence	68 (68%)	–
Prior treatment^b
Nephroureterectomy	7 (7%)	110 (11.6%)
Cystectomy	53 (53%)	269 (28.3%)
Neoadjuvant chemotherapy	5 (5%)	42 (4.4%)
Curative radiotherapy	7 (7%)	62 (6.5%)
Other^c	1 (1%)	–
ECOG PS at time of treatment decision
0	1 (1%)	341 (35.8%)
1	4 (4%)	321 (33.7%)
2	2 (2%)	135 (14.2%)
3	20 (20%)	5 (0.5%)
4	4 (4%)	0 (0%)
Unknown	69 (69%)	150 (15.8%)
Metastatic sites at time of treatment decision
Lymph nodes below the diaphragm	34 (34%)	484 (50.8%)
Lymph nodes above the diaphragm	4 (4%)	291 (30.6%)
Liver	32 (32%)	131 (13.8%)
Lungs	19 (19%)	263 (27.6%)
Bone	30 (30%)	148 (15.5%)
Brain	4 (4%)	5 (0.5%)
Pelvic soft tissue	23 (23%)	–
Other locations^d	3 (3%)	–
No metastases	4 (4%)	–
Unknown	0 (0%)	–
Examination of renal function at time of treatment decision
Cr-EDTA clearance	16 (16%)	–
eGFR	72 (72%)	–
No evaluation	12 (12%)	–
Mean Cr-EDTA clearance	40.3 ml/min (SD 23.1)	–
Mean eGFR clearance	58.1 ml/min (SD 24.9)	–

mUC: locally advanced, unresectable or metastatic urothelial carcinoma; IQR: interquartile range; ECOG PS: Eastern Cooperative Oncology Group performance status; Cr-EDTA clearance: Chromium-51-ethylenediamine tetraacetic acid clearance; eGFR: estimated glomerular filtration rate.

^a Predominant histologic subtype.

^b Registered only for min. T1 disease.

^c Resection of tumor tissue in upper urinary tract.

^d Other locations comprise: ovary (n = 1), pleura (n = 1), and bone marrow (n = 1).

Table 2. Reasons for lack of chemotherapy as indicated in the electronic medical records of 100 patients with mUC not receiving systemic anticancer treatment.

Reasons for lack of chemotherapy^a
Poor physical condition	59 (59%)
Decreased renal function	15 (15%)
Heart failure	1 (1%)
Hearing loss	0 (0%)
Peripheral neuropathy	0 (0%)
Other comorbidity	0 (0%)
Patient preferences	14 (14%)
Death before decision on anticancer treatment^b	4 (4%)
Unknown^c	11 (11%)
Patients evaluated at the oncology department	41 (41%)

^a Multiple reasons could be stated.

^b In patients diagnosed with mUC but without evaluation for chemotherapy and treatment initiation.

^c Only patients with no other registered reasons for not receiving chemotherapy.

Figure 2. Survival curve from diagnosis of mUC to death in 100 patients with mUC not receiving systemic anticancer treatment.

Table 3. Median OS plus 3-, 6- and 12-months OS rates in 100 patients with mUC not receiving systemic anticancer treatment and median OS in 952 patients with locally advanced, unresectable or metastatic urothelial tract cancer of different histologic subtypes who received SAT in Denmark during the same inclusion period.

	Present study (n = 100)	Omland et al. (2021) (n = 952)^18
Median OS, months (95% CI)	1.9 (1.6–2.8)	11.7 (10.8–12.5)
3 months OS, percent (95% CI)	35 (27–46)	–
6 months OS, percent (95% CI)	10 (6–18)	–
12 months OS, percent (95% CI)	5 (2–12)	–

OS: overall survival; CI: confidence interval.

Data availability statement

Data can be provided, except for personally identifiable information.