The overall survival (OS) improvement after the advent of several novel systemic therapies, designed for treatment of metastatic urothelial carcinoma of the urinary bladder (mUCUB), is not conclusively studied in either contemporary UCUB patients and/or non-UCUB patients. Within the Surveillance, Epidemiology, and End Results database, contemporary (2017-2020) and historical (2000-2016) systemic therapy-exposed metastatic UCUB and, subsequently, non-UCUB patients were identified. Separate Kaplan-Meier and multivariable Cox regression (CRM) analyses first addressed OS in mUCUB and, subsequently, in metastatic non-UCUB (mn-UCUB). Of 3443 systemic therapy-exposed patients, 2725 (79%) harbored mUCUB versus 709 (21%) harbored mn-UCUB. Of 2725 mUCUB patients, 582 (21%) were contemporary (2017-2020) versus 2143 (79%) were historical (2000-2016). In mUCUB, median OS was 11 months in contemporary versus 8 months in historical patients (Δ = 3 months; p < .0001). After multivariable CRM, contemporary membership status (2017-2020) independently predicted lower overall mortality (OM; hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.60-0.76; p < .001). Of 709 mn-UCUB patients, 167 (24%) were contemporary (2017-2020) and 542 (76%) were historical (2000-2016). In mn-UCUB, median OS was 8 months in contemporary versus 7 months in historical patients (Δ = 1 month; p = .034). After multivariable CRM, contemporary membership status (2017-2020) was associated with HR of 0.81 (95% CI = 0.66-1.01; p = .06). In conclusion, contemporary systemic therapy-exposed metastatic patients exhibited better OS in UCUB. However, the magnitude of survival benefit was threefold higher in mUCUB and approximated the survival benefits recorded in prospective randomized trials of novel systemic therapies.
International journal of cancer. 2024 Jul 03 [Epub ahead of print]
Francesco Di Bello, Carolin Siech, Letizia Maria Ippolita Jannello, Mario de Angelis, Natali Rodriguez Peñaranda, Zhe Tian, Jordan A Goyal, Andrea Baudo, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Fred Saad, Shahrokh F Shariat, Pietro Acquati, Ottavio de Cobelli, Alberto Briganti, Felix K H Chun, Salvatore Micali, Nicola Longo, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany., Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.