Investigating serum β-HCG as an independent prognostic factor in patients (pts) receiving chemotherapy (Ct) for transitional cell carcinoma (TCC) of the urothelial tract.
4549 Background: Serum human chorionic gonadotrophin β subunit (β-HCG) has prognostic value in TCC but has not been investigated in pts receiving Ct for this disease. Furthermore prior studies lacked statistical power to test independence from other prognostic variables. Methods: A single institution retrospective clinical database was constructed of pts receiving Ct between 2005 and 2011 for cancer of the urothelial tract. Eligible pts had pure or a component of TCC. Prognostic variables were tested by univariate Kaplan Meier analyses. Statistically significant variables were then assessed by multivariate cox regression analysis. A prospectively defined β-HCG cut-point of < versus ≥ 2 iu/L, either prior to (β-HCGp), or on completion of (β-HCGc) Ct was used. Results: 235 pts were eligible (72% male, 55% ≤70 years, 83% bladder primary). Initial Ct was perioperative (CtPeri) in 46% (7% adjuvant, 39% neoadjuvant). 63% had first line palliative Ct for metastatic disease (CtMet). For CtPeri, ECOG performance status (PS), haemoglobin (Hb), CtPeri regimen and T stage were statistically significant prognostic factors in univariate analyses for overall survival (OS), as were β-HCGp (median OS (mOS) 8.50 v. 1.86 years, p<0.001) and β-HCGc (mOS 4.27 v. 0.66 years, p=0.003). β-HCGp and β-HCGc after CtPeri were also prognostic for relapse free survival and in multivariable analysis remained statistically significant as a prognostic factor for OS (β-HCGp: hazard ratio (HR) 3.13, p=0.001; β-HCGc: HR 4.26, p=0.007). In pts treated with CtMet, PS, alkaline phosphatase, prior CtPeri, visceral metastases, CtMet regimen and β-HCGc (mOS 1.70 v. 1.07 years, p=0.005) were prognostic in univariate analyses for OS. β-HCGc after CtMet was also prognostic for progression free survival and in multivariable analysis remained statistically significant as a prognostic factor for OS (HR 3.47, p<0.001). Conclusions: β-HCG, and specifically its post-Ct level, is an independent prognostic factor for TCC treated with Ct in both curative and palliative settings. Prospective evaluation is warranted for incorporation into treatment selection strategies.