OUR CHEMOTHERAPY RESULTS IN PATIENTS WITH LOCALLY ADVANCED AND METASTATIC UROTHELIAL CANCER

Öz

This study evaluated the impact of substituting cisplatin with carboplatin in the first-line treatment and using single-agent gemcitabine as maintenance therapy on progression-free survival (PFS) and overall survival (OS) in patients with locally advanced or metastatic urothelial carcinoma who were ineligible for cisplatin. In addition, patients who received four cycles versus six cycles of cisplatin–gemcitabine or carboplatin–gemcitabine were compared. A total of 80 patients treated between January 2018 and January 2023 were retrospectively analyzed. Variables such as sex, age, tumor localization, sites of metastasis, number of chemotherapy cycles, and use of maintenance gemcitabine were evaluated. Kaplan-Meier method was used to compare survival and progression-free survival (PFS) between different clinical parameter groups, p-value <0.05 was considered statistically significant. The median OS was 23 months in female patients and 21 months in male patients. Median PFS was 46 months in males and 29 months in females, which was considered significant (p = 0.051). All patients received either cisplatin–gemcitabine or carboplatin–gemcitabine; among them, 24 patients received gemcitabine as maintenance therapy. The median PFS for the overall cohort was 6.7 months. In those who received gemcitabine maintenance, PFS was 46.7 months and considered statistically significant (p = 0.031), although no additional benefit was observed in OS. No OS difference was found between patients receiving four versus six cycles of chemotherapy; however, PFS was 18 months in patients who received four cycles compared with 59 months in those who received six cycles, which was significantly longer (p = 0.026). Maintenance therapy with gemcitabine and completing six cycles of chemotherapy may provide a favorable effect on PFS. These findings should be validated in larger, multicenter, prospective studies in advanced urothelial carcinoma.

Anahtar Kelimeler

• Carboplatin
• Carcinoma
• Chemotherapy
• Gemcitabine
• Metastasis

LOKAL İLERİ VE METASTATİK ÜROTELYAL KANSERLİ HASTALARDA KEMOTERAPİ SONUÇLARIMIZ

Öz

Bu çalışmada, sisplatin tedavisine uygun olmayan lokal ileri veya metastatik ürotelyal karsinomlu hastalarda birinci basamakta sisplatin yerine karboplatin kullanımı ve idame tedavide tek ajan gemsitabinin progresyonsuz sağkalım (PFS) ve genel sağkalım (OS) üzerine etkisi değerlendirildi. Ayrıca, dört kür ile altı kür sisplatin-gemsitabin veya karboplatin-gemsitabin tedavisi alan hastalar karşılaştırıldı. Ocak 2018-Ocak 2023 tarihleri arasında tedavi edilen 80 hasta retrospektif olarak analiz edildi. Cinsiyet, yaş, tümör lokalizasyonu, metastaz bölgeleri, kemoterapi kür sayısı ve idame gemsitabin kullanımı gibi değişkenler değerlendirildi. Çeşitli klinik parametre grupları arasında sağ kalım ve PFS sürelerinin karşılaştırılmasında Kaplan Meier yöntemi kullanılmıştır. p<0.05 istatistiki olarak anlamlı kabul edilmiştir. Genel olarak kadın hastalarda ortalama sağkalım 23 ay iken erkek hastalarda 21 ay olarak hesaplandı. Erkek hastalarda PFS 46 ay iken kadınlarda 29 ay olarak hesapladı ve bu durum anlamlı olarak kabul edildi (p = 0,051). Tüm hastalara sisplatin-gemsitabin veya karboplatingemsitabin verildi; 80 hastanın dahil edildiği çalışmada 14 hasta idame dönemde gemsitabin aldı. Ortalama PFS 6,7 ay idi. Sadece gemsitabin ile idame tedavi alanlarda PFS 46,7 ay olup anlamlı olarak kabul edilirken(p=0.031) OS açısından ek katkı saptanmadı. Dört kür ile altı kür kemoterapi alanlar arasında OS farkı gözlenmezken, dört kür tedavi alanlarda PFS 18 ay iken altı kür tedavi alanlarda PFS 59 ay idi ve bu anlamlı olarak uzun olarak değerlendirildi (p =0,026). Gemsitabin ile idame tedavi ve kemoterapinin altı küre tamamlanması, PFS üzerinde olumlu etki sağlayabilir. Bu sonuçlar, ileri evre ürotelyal karsinomda daha geniş, çok merkezli ve prospektif çalışmalarla doğrulanmalıdır.

Anahtar Kelimeler

• Karboplatin
• Kanser
• Kemoterapi
• Gemsitabine
• Metastaz

Kaynakça

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