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Association between comorbidities and survival in patients with metastatic urothelial carcinoma treated with pembrolizumab

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Abstract

Background

This study aims to investigate the relationship between comorbidities and survival in patients with mUC treated with pembrolizumab as a second-line treatment.

Methods

From February 2018 to October 2021, we analyzed the data of 185 consecutive patients with metastatic UC who received pembrolizumab as second-line therapy at The Jikei University Hospital and five affiliated hospitals. We used the Charlson Comorbidity Index (CCI) to assess the comorbidities. The outcomes of interest were progression-free survival (PFS) and overall survival (OS). To compare the survival differences, inverse probability of treatment weighting (IPTW)–adjusted Kaplan–Meier curves and the IPTW-adjusted Cox regression hazards model were used.

Results

After IPTW adjustment, patient characteristics were well-balanced between patients with high CCI and those with low CCI. The IPTW-adjusted Kaplan–Meier curves of PFS and OS based on CCI revealed that the patients with high CCI (2 or more) had a shorter PFS (median, 1.6 vs. 2.8 months) and a shorter OS (median, 12.4 vs. 18.8 months) (0–1). Similarly, in the IPTW-adjusted Cox regression hazards model, patients with high CCI had significantly shorter PFS [HR, 1.84 (95% CI 1.26–2.68; p = 0.002)] and OS [HR, 1.98 (95% CI 1.20–3.27; p = 0.008)] than those with lower CCI.

Conclusions

High CCI was associated with a higher risk of disease progression as well as overall mortality in mUC patients treated with second-line pembrolizumab.

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Abbreviations

AE:

Adverse event

CCI:

Charlson comorbidity index

CI:

Confidence interval

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

HRs:

Hazard ratios

ICIs:

Immune checkpoint inhibitors

IPTW:

Inverse probability treatment weighting

IQR:

Interquartile range

iRECIST:

Immunotherapy response evaluation criteria in solid tumors

MRI:

Magnetic resonance imaging

mUC:

Metastatic urothelial carcinoma

OR:

Odds ratio

OS:

Overall survival

PD-1:

Programmed death protein-1

PFS:

Progression-free survival

PPI:

Proton pump inhibitor

PS:

Performance status

RMST:

Restricted mean survival time

SMD:

Standardized mean difference

UC:

Urothelial carcinoma

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Acknowledgements

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Author information

Authors and Affiliations

  1. Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Masaki Hashimoto, Wataru Fukuokaya, Takafumi Yanagisawa, Shutaro Yamamoto, Yuhei Koike, Yu Imai, Kosuke Iwatani, Hajime Onuma, Kagenori Ito, Fumihiko Urabe, Shunsuke Tsuzuki, Shoji Kimura, Jun Miki & Takahiro Kimura

  2. Department of Medical Oncology, Kameda Medical Center, Kamogawa, Japan

    Yu Oyama

  3. Department of Urology, Kameda Medical Center, Kamogawa, Japan

    HIrokazu Abe

Authors
  1. Masaki Hashimoto
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  2. Wataru Fukuokaya
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  3. Takafumi Yanagisawa
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  4. Shutaro Yamamoto
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  13. Yu Oyama
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  14. HIrokazu Abe
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  15. Jun Miki
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  16. Takahiro Kimura
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Corresponding author

Correspondence to Masaki Hashimoto.

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An Institutional Reviewer Board approved the research protocol.

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Hashimoto, M., Fukuokaya, W., Yanagisawa, T. et al. Association between comorbidities and survival in patients with metastatic urothelial carcinoma treated with pembrolizumab. Int J Clin Oncol 29, 612–619 (2024). https://doi.org/10.1007/s10147-024-02482-7

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  • DOI: https://doi.org/10.1007/s10147-024-02482-7

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