Clin Genitourin Cancer. 2025 Jun 30;23(5):102395. doi: 10.1016/j.clgc.2025.102395. Online ahead of print.
ABSTRACT
INTRODUCTION: Retrospective data suggest poorer survival for female, racial minority, and older advanced urothelial carcinoma (aUC) patients. However, data on survival disparities in the modern era remain limited.
METHODS: This cohort study used Flatiron Health’s nationwide de-identified electronic health record (EHR)-derived database. Patients who initiated systemic therapy for aUC between January, 2017 and May, 2024 were included. Baseline characteristics, treatment history, and clinical outcomes were abstracted. PFS and OS were compared by sex (male vs. female), race (White, Black, vs. Asian/Pacific Islander [API]), and age at diagnosis (> 65 years [y] vs. ≤ 65 y), using Kaplan-Meier log-rank analysis and Cox proportional hazards models. Independent sample t-tests and chi-square analyses were used for univariate comparisons. P-values < .05 were considered statistically significant.
RESULTS: A total of 5142 patients with aUC were identified. 1419 were (28%) female and 575 (11%) were > 65 y. Of those with recorded race (n = 3492), 1% were API, 5% Black, 14% categorized as “other,” and 80% White. There was no difference in PFS (8.7 vs. 9.0 months [m], HR1.03; P = .82) or OS (13.2 vs. 13.5 m; HR1.05, P = .31) between women and men. Women had shorter PFS to men on immune checkpoint inhibitors (ICI) (P = .002) but not with other first-line (1L) therapy. API patients had comparable PFS (9.6 vs. 8.9 m; HR0.91; P = .45) but longer OS (28.5 vs. 14.1 m; HR0.56; P = .008) compared to White patients. Black patients had comparable PFS (7.9 vs. 8.5; HR1.06; P = .81) and OS (11.5 vs. 14.1 m; HR1.32; P = .73) vs White patients. Patients > 65 y had shorter PFS to ≤ 65 y (7.6 vs. 9.0 m; HR1.14, P = .019); however, OS was longer in older patients (16.5 vs. 12.8 m; HR0.80, P < .001). Only on 1L ICI, OS was longer in those > 65 y compared to those ≤ 65 y (HR0.71; P = .021) CONCLUSION: In this large real-world database, female aUC patients had comparable PFS and OS to males. API patients showed superior OS to White patients. Patients > 65 y had inferior PFS but superior OS to patients ≤ 65 y.
PMID:40712200 | DOI:10.1016/j.clgc.2025.102395
