Prognostic factors and significance of chemotherapy in patients with recurrent or metastatic transitional cell cancer of the urinary tract.

Background. Prognosticfactors for patients with disseminated transitional cell carcinomaof the urothelium(TCC) has been examined only in patients selected for studies with chemotherapy. This study was performed to determine important prognosticfactors in patients with disseminatedTCC and evaluate the impact of chemotherapy. Methods. The prognosticfactors for survival were analyzed in 240 patients with disseminatedTCC admitted from 1976 to 1992. Information on prior medical history, baseline variables, and treatment were related to survival after dissemination. Both univariate and multivariate analyses were performed to identify factors of independent importance. Results. Univariate analyses indicated that performance status; hemoglobin; leukocyte count; platelet count; concentrations of serum creatinine, aspartate aminotransferase, lactate dehydrogenase, and alkaline phosphatase; hydronephrosis; bone metastases; disease extension; and chemotherapy were related significantly to survival. Multivariate analysis demonstrated that a good performance status, a normal alkaline phosphataseconcentration, and a normal serum creatinine concentration were independent prognosticatorsfor long survival. When chemotherapy was included in the analysis, it was found to be the most important independent prognosticfactor in conjunction with alkaline phosphataseand performance status. Conclusion. This study has established the importance of performance statusand alkaline phosphataseas the most important prognosticfactors of survival in patients with disseminatedTCC regardless of treatment. Chemotherapy was found to be an independent prognostic variablethat indicates a possible prolongation of survival in patients receiving chemotherapy.