Rebuzzi Sara Elena, Banna Giuseppe Luigi, Murianni Veronica, Damassi Alessandra, Giunta Emilio Francesco, Fraggetta Filippo, De Giorgi Ugo, Cathomas Richard, Rescigno Pasquale, Brunelli Matteo, Fornarini Giuseppe
Medical Oncology, Ospedale San Paolo, 17100 Savona, Italy.
Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy.
Cancers (Basel). 2021 Nov 3;13(21):5517. doi: 10.3390/cancers13215517.
In recent years, the treatment landscape of urothelial carcinoma has significantly changed due to the introduction of immune checkpoint inhibitors (ICIs), which are the standard of care for second-line treatment and first-line platinum-ineligible patients with advanced disease. Despite the overall survival improvement, only a minority of patients benefit from this immunotherapy. Therefore, there is an unmet need to identify prognostic and predictive biomarkers or models to select patients who will benefit from ICIs, especially in view of novel therapeutic agents. This review describes the prognostic and predictive role, and clinical readiness, of clinical and tumour factors, including new molecular classes, tumour mutational burden, mutational signatures, circulating tumour DNA, programmed death-ligand 1, inflammatory indices and clinical characteristics for patients with urothelial cancer treated with ICIs. A classification of these factors according to the levels of evidence and grades of recommendation currently indicates both a prognostic and predictive value for ctDNA and a prognostic relevance only for concomitant medications and patients' characteristics.
近年来，由于免疫检查点抑制剂（ICI）的引入，尿路上皮癌的治疗格局发生了显著变化，ICI是晚期疾病二线治疗和一线铂类不适用患者的标准治疗方法。尽管总体生存率有所提高，但只有少数患者能从这种免疫治疗中获益。因此，迫切需要识别预后和预测生物标志物或模型，以选择能从ICI中获益的患者，特别是考虑到新型治疗药物。本综述描述了临床和肿瘤因素（包括新的分子类别、肿瘤突变负荷、突变特征、循环肿瘤DNA、程序性死亡配体1、炎症指标以及接受ICI治疗的尿路上皮癌患者的临床特征）的预后和预测作用以及临床应用准备情况。根据证据水平和推荐等级对这些因素进行分类，目前表明循环肿瘤DNA既有预后价值也有预测价值，而伴随用药和患者特征仅具有预后相关性。
