Metastatic Urothelial Cancer: Evaluation of Prognostic Factors and Change in Prognosis during the Last Twenty Years

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Abstract
Objective: This study was designed to establish prognostic factors for survival of patients with locally advanced or metastatic urothelial cancer. We have furthermore investigated changes in patient characteristics and treatment strategies during the last 20 years. Patients and Methods: Between 1992 and 1997, a total of 156 patients with newly diagnosed recurrent locally advanced disease (nonresectable, radioresistant) and/or metastatic transitional cell carcinoma of the urothelial tract were included in a protocol evaluating clinical and laborattory prognostic factors at baseline. The relationship between these characteristics and survival was analyzed using univariate and multivariate methods. The results were compared to the survival results of similar patients treated previously from 1976 to 1991. Results: Median survival after diagnosis of recurrent locally advanced or metastatic disease was 5.8 months. Multivariate analysis showed that good performance status (PS), normal alkaline phosphatase (AP), absence of liver metastases and chemotherapy were independent prognostic factors for long survival. An increase in survival was found when comparison was made with 240 patients treated in the period from 1976 to 1991, but the period of treatment had no independent importance in multivariate analysis. Conclusion: PS, AP and liver metastases are the major important prognostic factors in metastatic urothelial cancer. Stage migration and increased use of chemotherapy may have contributed to improved median survival during the last 20 years.

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