# Prognostic Factors in Metastatic Urothelial Carcinoma Treated Without Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (M-VAC): A Single-Center Retrospective Study

## TL;DR

This study identifies factors like ECOG performance status and hemoglobin levels that predict survival in patients with metastatic bladder cancer.

## Contribution

A new prognostic model for metastatic urothelial carcinoma is developed using clinical parameters in patients not treated with M-VAC chemotherapy.

## Key findings

- Patients with ECOG PS 0 had significantly longer progression-free and overall survival.
- Normal baseline hemoglobin levels were associated with better survival outcomes.
- Transitional epithelial carcinoma was linked to improved survival compared to non-transitional types.

## Abstract

Background

Bladder cancer represents the most prevalent malignancy of the urinary tract. This study aimed to develop a prognostic model for patients with metastatic urothelial carcinoma.

Methodology

This retrospective study included a total of 49 patients who received chemotherapy for metastatic bladder cancer. Clinical and pathological parameters were analyzed to evaluate their prognostic value.

Results

The median progression-free survival (PFS) was calculated as 8.20 months. Patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 had a significantly longer PFS (21.83 months) compared to those with a PS of 1 (5.20 months; p < 0.001). PFS was also significantly longer in patients with transitional epithelial cell carcinoma (10.87 months) compared to those with non-transitional epithelial carcinoma (4.90 months; p = 0.012). Additionally, patients with normal baseline hemoglobin levels demonstrated a longer PFS (12.57 months) than anemic patients (5.20 months; p = 0.002). The median overall survival (OS) was calculated as 15.80 months. Patients with a body mass index (BMI) <25 kg/m² had a median OS of 11.20 months, whereas those with a BMI >25 kg/m² had an OS of 21.30 months (p = 0.003). Patients with transitional epithelial carcinoma had a median OS of 16.30 months, compared to 12.33 months in patients with non-transitional epithelial carcinoma (p = 0.014). Similarly, patients with normal hemoglobin levels had a significantly longer OS (21.30 months) than those with anemia (11.73 months; p = 0.011).

Conclusions

Our findings demonstrate that a baseline ECOG PS of 0 is significantly associated with improved PFS and OS in patients with metastatic urothelial carcinoma. Furthermore, lower pretreatment hemoglobin levels were found to be associated with poorer survival outcomes. The study also identified high white blood cell count, normal platelet count, low neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, low albumin, and low lactate dehydrogenase levels as favorable prognostic indicators in this patient population. These results contribute to the growing body of literature aimed at optimizing prognostic assessment in metastatic bladder cancer.