Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan; Translational Research Program, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Urol Oncol. 2022 Jul;40(7):344.e11-344.e17. doi: 10.1016/j.urolonc.2022.02.012. Epub 2022 Mar 26.
Most patients with metastatic urothelial carcinoma experience no objective response to pembrolizumab and have poor overall survival (OS). Here, we investigated the prognostic value of fluctuation in the neutrophil-lymphocyte ratio (NLR) at 6 weeks of pembrolizumab treatment, focusing on its association with the achievement of objective response.
The clinical records of 177 metastatic urothelial carcinoma patients treated with pembrolizumab were retrospectively analyzed.
The median age was 72 years, and the median OS was 14 months. The objective response rate in the total cohort was 26.5% (47 of 177 patients). Multivariable analysis showed that objective response achievement (hazard ratio 0.3 [95% confidence interval 0.15-0.59], P < 0.001) and decline in NLR from that at baseline at 6 weeks of treatment (0.54 [0.34-0.88], P = 0.013) were independent prognostic factors for improved OS. For 47 (26.5%) patients who achieved an objective response, OS was similar regardless of NLR fluctuation at 6 weeks of treatment (P = 0.723). Intriguingly, of the 130 (73.5%) patients with no objective response, those who showed a decreased NLR at 6 weeks of pembrolizumab treatment (57 patients) from that at baseline had significantly longer OS than those with elevated NLR (73 patients) (14 vs. 6 months, P = 0.007).
The fluctuation in NLR from that at baseline at 6 weeks of pembrolizumab treatment may be useful for patients without an objective response. This could potentially aid decision-making for post pembrolizumab therapies.
大多数转移性尿路上皮癌患者对派姆单抗无客观缓解，总体生存（OS）较差。在此，我们研究了派姆单抗治疗 6 周时中性粒细胞-淋巴细胞比值（NLR）波动的预后价值，重点关注其与客观缓解的相关性。
回顾性分析了 177 例接受派姆单抗治疗的转移性尿路上皮癌患者的临床记录。
中位年龄为 72 岁，中位 OS 为 14 个月。总队列的客观缓解率为 26.5%（177 例患者中的 47 例）。多变量分析表明，客观缓解的获得（危险比 0.3 [95%置信区间 0.15-0.59]，P < 0.001）和治疗 6 周时 NLR 从基线下降（0.54 [0.34-0.88]，P=0.013）是改善 OS 的独立预后因素。对于 47 例（26.5%）获得客观缓解的患者，无论治疗 6 周时 NLR 波动如何，OS 相似（P=0.723）。有趣的是，在 130 例（73.5%）无客观缓解的患者中，与基线相比，在派姆单抗治疗 6 周时 NLR 降低（57 例）的患者 OS 明显长于 NLR 升高（73 例）的患者（14 个月 vs. 6 个月，P=0.007）。
派姆单抗治疗 6 周时 NLR 从基线的波动可能对无客观缓解的患者有用。这可能有助于派姆单抗治疗后决策。
