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Background/Aim: Predicting the prognosis of metastatic urothelial carcinoma (mUC) patients is needed for clinical decisions. We examined the value of a modified Glasgow prognostic score (mGPS) as a predictive marker for mUC patients. Patients and Methods: In a multicenter study, 68 mUC patients received short hydration gemcitabine/ cisplatin (shGC) and 74 received pembrolizumab (PEM). Patients were allocated according to mGPS. Progression-free (PFS) and cancer-specific (CSS) survival were examined. Results: Higher mGPS reflected poorer PFS and CSS in shGC (p=0.03, p<0.0001, respectively) and PEM (p=0.02, p<0.001, respectively) patients. PFS for the high mGPS group was longer than that of the low mGPS group in the two cohorts (p <0.0001 for both), with similar CSS results (p<0.0001 and p<0.001, respectively). Multivariate analyses revealed high mGPS was a risk factor for poor CSS in both cohorts (HR=3.55, p<0.001, and HR=2.21, p<0.01, respectively). Conclusion: In the mUC patients receiving shGC or PEM, mGPS was a predictive prognostic marker.The incidence of bladder cancer is rising but the mortality rate has recently become reduced with improved treatment (1). However, for patients with metastatic urothelial carcinoma (mUC) the 5-year survival rate is approximately 5% and its prognosis appears poor (2). Evidence from several regimens has been used to improve the prognosis of mUC. Cisplatin-based chemotherapy is recommended as first-line treatment for mUC in National Comprehensive Cancer Network (NCCN) guidelines (3, 4). For decades, evidence from second-line therapy has been lacking. Recently, the efficacy of pembrolizumab (PEM) was described (5), which became the preferred regimen of second-line therapy for mUC under NCCN guidelines (4). However, the optimal timing of a switch in drug has not been established and a definitive prognostic marker for supporting drug selection is lacking. In this regard, useful biomarkers have appeared to assist physicians in identifying the timing of the cessation of the administration of drugs that lost their efficacy over time in patients with advanced cancers.Several evaluation methods related to nutrition or inflammation have been identified that can be used to assess the prognosis of cancer patients. Useful prognostic markers for mUC based on drugs have been reported previously. Predictive factors for the prognosis of patients with mUC who received cisplatin-based chemotherapy are: performance status (PS), hemoglobin levels, and liver metastasis (6). Sarcopenia, a quantitative measure of a loss in muscle mass and strength, is as a prognostic marker of patients with mUC who received gemcitabine and cisplatin (GC) (7). In a previous report, we described how the progression of sarcopenia was also considered a predictive marker of overall survival as found in patients with mUC who underwent gemcitabine and docetaxel treatment as secondline therapy (8). In research on biomarkers using blood samples, the neutrophil-lymphocyte ratio was also shown to reflect the response of pat...

<b><i>Objectives:</i></b> The aim of the study was to examine the effectiveness of a modified-short hydration gemcitabine and cisplatin (m-shGC) regimen for patients with metastatic urothelial carcinoma (mUC) and to assess the efficacy of a geriatric nutritional risk index (GNRI) with regard to prognosis. <b><i>Patients and Methods:</i></b> From January 2016 to July 2020, 68 patients with mUC underwent first-line m-shGC therapy with 70 mg/m² cisplatin and 1,000 mg/m² gemcitabine (days 1, 8, and 15), with 2,050 mL fluid replaced on the first day of each 28-day cycle. Prior to the start of treatment, the serum neutrophil-to-lymphocyte ratio (NLR), and levels of albumin and C-reactive protein (CRP) in serum, as well as body heights and weights were measured. Patients were grouped according to GNRI &#x3c;92 (low) or ≥92 (high). The analysis of data was done retrospectively. <b><i>Results:</i></b> Median follow-up was found to be 12.9 (range 1.7–50.2) months and the objective response rate (ORR) was 54.4% after m-shGC treatment. The ORR was significantly different when high and low-GNRI groups were compared (ORR: 28.0 vs. 69.8% in low- vs. high-GNRI groups). Median overall survival (OS) was calculated as 8.6 (95% confidence interval [CI]: 5.4–21.3) and 34.5 (95% CI: 20.5–NA) months for low- and high-GNRI groups, respectively (<i>p</i> &#x3c; 0.0001). Unlike for NLR and CRP, univariate and multivariate analyses revealed that low GNRI and visceral metastases were significant prognostic factors for short OS. <b><i>Conclusions:</i></b> First-line m-shGC showed a survival benefit for mUC, with GNRI a useful prognostic biomarker.

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Introduction: This study evaluated the prognostic value of a sustained high geriatric nutritional risk index (GNRI) during first-line chemotherapy for patients with metastatic urothelial carcinoma (mUC). Methods: Between January 2018 and February 2022, 123 patients received platinum-based chemotherapy at Nagoya City University Hospital and affiliated institutions. Of these, 118 eligible patients that showed an Eastern Cooperative Oncology Group performance status (ECOG–PS) between 0 and 2 were retrospectively examined. Based on body mass index and serum albumin levels, GNRI was calculated immediately before and after the first primary chemotherapy cycle. Patients were divided into two groups based on GNRI: GNRI sustained  92 in sustainable (n=63), and GNRI < 92 in unsustainable (n=55) groups, respectively. Clinical outcomes were compared. Results: No significant differences were noted between the two groups including for age, gender, cycle of first-line treatment, and type of series of sequential treatments after failure of first-line therapy. Median overall survival from the start of first-line chemotherapy was 30.2 months (95% confidence interval [CI]: 20.9–NA) for sustainable and 12.6 months (95% CI: 9.0–21.2) for unsustainable groups, respectively (p < 0.05). Multivariate analysis identified ECOG–PS:2 and fatigue, an adverse event, as independent predictors of unsustainable GNRI transition (95% CI: 1.29–90.6, odds ratio [OR]: 10.8; 95% CI: 1.06–26.9, OR: 5.34, respectively). Conclusion/Conclusion: Sustaining a high level of GNRI was an important prognostic indicator in patients with mUC receiving first-line chemotherapy. Appropriate intervention for controlling adverse events, including fatigue, may enhance physical strength during cancer treatment.