Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens

Joaquim Bellmunt; Toni K Choueiri; Ronan Fougeray; Fabio A B Schutz; Yacine Salhi; Eric Winquist; Stéphane Culine; Hans von der Maase; David J Vaughn; Jonathan E Rosenberg

doi:10.1200/jco.2009.25.4599

Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens

Joaquim Bellmunt, Toni K Choueiri, Ronan Fougeray, Fabio A B Schutz, Yacine Salhi, Eric Winquist, Stéphane Culine, Hans von der Maase, David J Vaughn, Jonathan E Rosenberg

248 Citations (Scopus)

Abstract

Purpose: The present study sought to identify pretreatment prognostic factors for overall survival (OS) in patients with metastatic transitional cell carcinoma of the urothelial tract (TCCU) who experienced treatment failure with the first-line, platinum-based regimen included in the phase III vinflunine trial. Patients and Methods: In total, 370 patients with platinum-refractory TCCU were included in this analysis. Potential prognostic factors were recorded prospectively. Univariate analysis was used to identify clinical and laboratory factors that significantly impact survival. Multivariate analysis was used to identify independent prognostic factors, and bootstrap analysis was performed for internal validation, forming a prognostic model. External validation was performed on the phase II vinflunine study CA183001. Results: Multivariate analysis and the internal validation identified Eastern Cooperative Oncology Group performance status (PS) more than 0, hemoglobin level less than 10 g/dL, and the presence of liver metastasis as the main adverse prognostic factors for OS. External validation confirmed these prognostic factors. Four subgroups were formed based on the presence of zero, one, two, or three prognostic factors; the median OS times for these groups were 14.2, 7.3, 3.8, and 1.7 months (P < .001), respectively. Conclusion: We identified and both internally and externally validated three adverse risk factors (PS, hemoglobin level, and liver metastasis) that predict for OS and developed a scoring system that classifies patients with platinum-refractory disease on second-line chemotherapy into four risk groups with different outcome. Similar to the first-line setting, the presence of visceral metastases and poor PS predict a worse prognosis. These factors, together with low hemoglobin, can be used for prognostication and future patient stratification in clinical trials.

Original language	English
Journal	Journal of Clinical Oncology
Volume	28
Issue number	11
Pages (from-to)	1850-5
Number of pages	6
ISSN	0732-183X
DOIs	https://doi.org/10.1200/jco.2009.25.4599
Publication status	Published - 10 Apr 2010

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Bellmunt, J., Choueiri, T. K., Fougeray, R., Schutz, F. A. B., Salhi, Y., Winquist, E., Culine, S., Maase, H. V. D., Vaughn, D. J., & Rosenberg, J. E. (2010). Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. Journal of Clinical Oncology, 28(11), 1850-5. https://doi.org/10.1200/jco.2009.25.4599

Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. / Bellmunt, Joaquim; Choueiri, Toni K; Fougeray, Ronan et al.

In: Journal of Clinical Oncology, Vol. 28, No. 11, 10.04.2010, p. 1850-5.

Research output: Contribution to journal › Journal article › Research › peer-review

Bellmunt, J, Choueiri, TK, Fougeray, R, Schutz, FAB, Salhi, Y, Winquist, E, Culine, S, Maase, HVD, Vaughn, DJ & Rosenberg, JE 2010, 'Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens', Journal of Clinical Oncology, vol. 28, no. 11, pp. 1850-5. https://doi.org/10.1200/jco.2009.25.4599

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title = "Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens",

abstract = "Purpose: The present study sought to identify pretreatment prognostic factors for overall survival (OS) in patients with metastatic transitional cell carcinoma of the urothelial tract (TCCU) who experienced treatment failure with the first-line, platinum-based regimen included in the phase III vinflunine trial. Patients and Methods: In total, 370 patients with platinum-refractory TCCU were included in this analysis. Potential prognostic factors were recorded prospectively. Univariate analysis was used to identify clinical and laboratory factors that significantly impact survival. Multivariate analysis was used to identify independent prognostic factors, and bootstrap analysis was performed for internal validation, forming a prognostic model. External validation was performed on the phase II vinflunine study CA183001. Results: Multivariate analysis and the internal validation identified Eastern Cooperative Oncology Group performance status (PS) more than 0, hemoglobin level less than 10 g/dL, and the presence of liver metastasis as the main adverse prognostic factors for OS. External validation confirmed these prognostic factors. Four subgroups were formed based on the presence of zero, one, two, or three prognostic factors; the median OS times for these groups were 14.2, 7.3, 3.8, and 1.7 months (P < .001), respectively. Conclusion: We identified and both internally and externally validated three adverse risk factors (PS, hemoglobin level, and liver metastasis) that predict for OS and developed a scoring system that classifies patients with platinum-refractory disease on second-line chemotherapy into four risk groups with different outcome. Similar to the first-line setting, the presence of visceral metastases and poor PS predict a worse prognosis. These factors, together with low hemoglobin, can be used for prognostication and future patient stratification in clinical trials.",

author = "Joaquim Bellmunt and Choueiri, {Toni K} and Ronan Fougeray and Schutz, {Fabio A B} and Yacine Salhi and Eric Winquist and St{\'e}phane Culine and Maase, {Hans von der} and Vaughn, {David J} and Rosenberg, {Jonathan E}",

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doi = "10.1200/jco.2009.25.4599",

language = "English",

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T1 - Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens

AU - Bellmunt, Joaquim

AU - Choueiri, Toni K

AU - Fougeray, Ronan

AU - Schutz, Fabio A B

AU - Salhi, Yacine

AU - Winquist, Eric

AU - Culine, Stéphane

AU - Maase, Hans von der

AU - Vaughn, David J

AU - Rosenberg, Jonathan E

PY - 2010/4/10

Y1 - 2010/4/10

N2 - Purpose: The present study sought to identify pretreatment prognostic factors for overall survival (OS) in patients with metastatic transitional cell carcinoma of the urothelial tract (TCCU) who experienced treatment failure with the first-line, platinum-based regimen included in the phase III vinflunine trial. Patients and Methods: In total, 370 patients with platinum-refractory TCCU were included in this analysis. Potential prognostic factors were recorded prospectively. Univariate analysis was used to identify clinical and laboratory factors that significantly impact survival. Multivariate analysis was used to identify independent prognostic factors, and bootstrap analysis was performed for internal validation, forming a prognostic model. External validation was performed on the phase II vinflunine study CA183001. Results: Multivariate analysis and the internal validation identified Eastern Cooperative Oncology Group performance status (PS) more than 0, hemoglobin level less than 10 g/dL, and the presence of liver metastasis as the main adverse prognostic factors for OS. External validation confirmed these prognostic factors. Four subgroups were formed based on the presence of zero, one, two, or three prognostic factors; the median OS times for these groups were 14.2, 7.3, 3.8, and 1.7 months (P < .001), respectively. Conclusion: We identified and both internally and externally validated three adverse risk factors (PS, hemoglobin level, and liver metastasis) that predict for OS and developed a scoring system that classifies patients with platinum-refractory disease on second-line chemotherapy into four risk groups with different outcome. Similar to the first-line setting, the presence of visceral metastases and poor PS predict a worse prognosis. These factors, together with low hemoglobin, can be used for prognostication and future patient stratification in clinical trials.

AB - Purpose: The present study sought to identify pretreatment prognostic factors for overall survival (OS) in patients with metastatic transitional cell carcinoma of the urothelial tract (TCCU) who experienced treatment failure with the first-line, platinum-based regimen included in the phase III vinflunine trial. Patients and Methods: In total, 370 patients with platinum-refractory TCCU were included in this analysis. Potential prognostic factors were recorded prospectively. Univariate analysis was used to identify clinical and laboratory factors that significantly impact survival. Multivariate analysis was used to identify independent prognostic factors, and bootstrap analysis was performed for internal validation, forming a prognostic model. External validation was performed on the phase II vinflunine study CA183001. Results: Multivariate analysis and the internal validation identified Eastern Cooperative Oncology Group performance status (PS) more than 0, hemoglobin level less than 10 g/dL, and the presence of liver metastasis as the main adverse prognostic factors for OS. External validation confirmed these prognostic factors. Four subgroups were formed based on the presence of zero, one, two, or three prognostic factors; the median OS times for these groups were 14.2, 7.3, 3.8, and 1.7 months (P < .001), respectively. Conclusion: We identified and both internally and externally validated three adverse risk factors (PS, hemoglobin level, and liver metastasis) that predict for OS and developed a scoring system that classifies patients with platinum-refractory disease on second-line chemotherapy into four risk groups with different outcome. Similar to the first-line setting, the presence of visceral metastases and poor PS predict a worse prognosis. These factors, together with low hemoglobin, can be used for prognostication and future patient stratification in clinical trials.

U2 - 10.1200/jco.2009.25.4599

DO - 10.1200/jco.2009.25.4599

M3 - Journal article

C2 - 20231682

SN - 0732-183X

VL - 28

SP - 1850

EP - 1855

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 11

ER -

Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens

Abstract

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