Metastatic urinary tract cancer (mUTC) is challenging to treat in older adults due to comorbidities. We compared the clinical courses of younger and older (≥70 years) adults with mUTC receiving first-line (1L) systemic therapy in a tertiary cancer center. Baseline clinical characteristics, treatments received, tolerability, and survival outcomes were analyzed. Among 212 patients (103 older vs. 109 younger), the older patients had lower hemoglobin at baseline (84% vs. 71%,p= 0.03), the majority were cisplatin-ineligible (74% vs. 45%,p< 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%,p= 0.01), received fewer subsequent lines of treatment (median 0 vs. 1,p= 0.003), and had lower clinical trial participation (30% vs. 18%,p= 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%,p= 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5,p= 0.01). Older patients had similar OS (11.2 months vs. 14 months,p= 0.06) and similar rates of treatment-related severe toxicity and healthcare visits, independent of the type of systemic treatment received, compared to younger patients. We conclude that select older adults with mUTC can be safely treated with immunotherapy and risk-adjusted regimens of chemotherapy with tangible survival benefits.
转移性尿路癌（mUTC）因合并症的存在，在老年患者中治疗难度较大。本研究于一家三级癌症中心，比较了接受一线（1L）系统治疗的年轻与老年（≥70岁）mUTC患者的临床病程。分析内容包括基线临床特征、治疗方案、耐受性及生存结局。在212例患者（老年组103例 vs. 年轻组109例）中，老年组基线血红蛋白水平较低（84% vs. 71%，p=0.03），多数不适合接受顺铂治疗（74% vs. 45%，p<0.001），一线治疗中更多接受免疫治疗（52% vs. 36%，p=0.01），后续治疗线数较少（中位数0 vs. 1，p=0.003），且临床试验参与率较低（30% vs. 18%，p=0.05）。在接受一线化疗的患者中，老年组需要更多剂量调整（53.4% vs. 23%，p=0.001）且接受化疗周期数较少（中位数4 vs. 5，p=0.01）。尽管存在这些差异，老年组与年轻组的总生存期相近（11.2个月 vs. 14个月，p=0.06），治疗相关严重毒性及医疗就诊率亦无显著差异，且此结果与接受的具体系统治疗类型无关。本研究结论表明，经筛选的老年mUTC患者可安全接受免疫治疗及风险调整后的化疗方案，并能获得明确的生存获益。
肿瘤(癌症)患者之家