Serum total hCGβ level is an independent prognostic factor in transitional cell carcinoma of the urothelial tract

Abstract

Background: Serum total human chorionic gonadotrophin β subunit (hCGβ) level might have prognostic value in urothelial transitional cell carcinoma (TCC) but has not been investigated for independence from other prognostic variables.

Methods: We utilised a clinical database of patients receiving chemotherapy between 2005 and 2011 for urothelial TCC and an independent cohort of radical cystectomy patients for validation purposes. Prognostic variables were tested by univariate Kaplan-Meier analyses and log-rank tests. Statistically significant variables were then assessed by multivariate Cox regression. Total hCGβ level was dichotomised at < vs ≥2 IU l(-1).

Results: A total of 235 chemotherapy patients were eligible. For neoadjuvant chemotherapy, established prognostic factors including low ECOG performance status, normal haemoglobin, lower T stage and suitability for cisplatin-based chemotherapy were associated with favourable survival in univariate analyses. In addition, low hCGβ level was favourable when assessed either before (median survival not reached vs 1.86 years, P=0.001) or on completion of chemotherapy (4.27 vs 0.42 years, P=0.000002). This was confirmed in multivariate analyses and in patients receiving first- and second-line palliative chemotherapy, and in a radical cystectomy validation set.

Conclusions: Serum total hCGβ level is an independent prognostic factor in patients receiving chemotherapy for urothelial TCC in both curative and palliative settings.

Figure 1

Flow diagram for chemotherapy cohorts used in this study.

Figure 2

Total hCGβ levels before chemotherapy for patients undergoing neoadjuvant, first-line or second-line chemotherapy.

Figure 3

Kaplan–Meier plots to show overall survival according to total hCGβ level in the neoadjuvant (A, B) or first-line (C, D) chemotherapy cohorts either before (A, C), or on completion of (B, D) chemotherapy. Broken line – hCGβ level ⩾2; continuous line – hCGβ level <2.

Figure 4

Kaplan–Meier plot to show overall survival according to total hCGβ level in a radical cystectomy cohort. Broken line – hCGβ level ⩾2; continuous line – hCGβ level <2.