Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Department of Urology, National Cancer Center Hospital, Tokyo, Japan.
BJU Int. 2022 Aug;130(2):226-234. doi: 10.1111/bju.15510. Epub 2021 Jul 6.
To assess the impact of histological variants on survival and response to treatment with pembrolizumab in patients with chemo-resistant urothelial carcinoma (UC).
The medical records of 755 patients with advanced UC who received pembrolizumab were reviewed retrospectively. Patients were classified into pure UC (PUC) and each variant. Best overall response (BOR) and overall survival (OS) were compared between the groups using a propensity score matching (PSM).
Overall, 147 (19.5%) patients harboured any histological variant UC (VUC). After PSM, there were no significant differences in the objective response rate (ORR, 24.5% vs 17.3%, P = 0.098) or disease control rate (DCR, 36.7% vs 30.2%, P = 0.195) when comparing patients with any VUC and PUC. Furthermore, any VUC, as compared with PUC, was associated with a similar risk of death (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.68-1.20; P = 0.482). Squamous VUC, which was the most frequent variant in the cohort, had a comparable ORR, DCR and OS as compared with PUC or non-squamous VUC. The patients with sarcomatoid VUC (n = 19) had significantly better ORR (36.8%, P = 0.031), DCR (52.6%, P = 0.032), and OS (HR 0.37, 95% CI 0.15-0.90; P = 0.023) compared to patients with PUC.
The presence of variant histology did not seem to affect BOR or OS after pembrolizumab administration in patients with chemo-resistant UC. The patients with sarcomatoid VUC achieved favourable responses and survival rates compared to PUC.
评估组织学变异对化疗耐药性尿路上皮癌（UC）患者接受 pembrolizumab 治疗的生存和反应的影响。
回顾性分析了 755 例接受 pembrolizumab 治疗的晚期 UC 患者的病历。患者分为纯 UC（PUC）和各变异型。使用倾向评分匹配（PSM）比较两组之间的最佳总体反应（BOR）和总生存期（OS）。
总体而言，147（19.5%）例患者存在任何组织学变异 UC（VUC）。PSM 后，比较任何 VUC 与 PUC 患者的客观缓解率（ORR，24.5%比 17.3%，P=0.098）或疾病控制率（DCR，36.7%比 30.2%，P=0.195）无显著差异。此外，与 PUC 相比，任何 VUC 与死亡风险相似（风险比[HR]0.90，95%置信区间[CI]0.68-1.20；P=0.482）。在该队列中最常见的变异型鳞状 VUC 与 PUC 或非鳞状 VUC 的 ORR、DCR 和 OS 相当。与 PUC 患者相比，肉瘤样 VUC（n=19）患者的 ORR（36.8%，P=0.031）、DCR（52.6%，P=0.032）和 OS（HR0.37，95%CI0.15-0.90；P=0.023）明显更好。
在化疗耐药性 UC 患者中，变体组织学的存在似乎不会影响 pembrolizumab 治疗后的 BOR 或 OS。与 PUC 相比，肉瘤样 VUC 患者的反应和生存率较好。
