Miura Yuki, Hatakeyama Shingo, Tanaka Toshikazu, Fujita Naoki, Horiguchi Hirotaka, Okuyama Yoshiharu, Kojima Yuta, Noro Daisuke, Tokui Noriko, Okamoto Teppei, Yamamoto Hayato, Ito Hiroyuki, Yoneyama Takahiro, Hashimoto Yasuhiro, Ohyama Chikara
Department of Urology Hirosaki University Graduate School of Medicine Hirosaki Japan.
Department of Urology Aomori Prefectural Central Hospital Aomori Japan.
BJUI Compass. 2021 Oct 8;3(2):146-153. doi: 10.1002/bco2.117. eCollection 2022 Mar.
To evaluate the effect of postoperative pathological findings related to the eligibility of adjuvant immunotherapy on oncologic outcomes in patients with localized and locally advanced muscle-invasive bladder carcinoma (MIBC) and upper tract urothelial carcinoma (UTUC).
We retrospectively evaluated 1082 patients treated with radical cystectomy ( = 597) and nephroureterectomy ( = 485) between January 2000 and April 2021. Patients were divided into two groups: pT3-4 or pN+ without neoadjuvant chemotherapy and ypT2-4 or pN+ treated with neoadjuvant chemotherapy (trial-eligible group) or others (trial-ineligible group). The primary outcome was the effect of trial eligibility for adjuvant immunotherapy on disease-free survival (DFS) and overall survival (OS). Secondary outcomes included the additional effect of lymphovascular invasion (LVI) status to the clinical trial criteria on prognosis and a risk model development.
The median ages of the patients were 69 and 72 years in the MIBC and UTUC groups, respectively. Fifty-two percent of patients met the trial inclusion criteria. Trial eligibility was significantly associated with poor DFS and OS among patients with MIBC and UTUC. LVI-positive status was significantly associated with poor prognosis among patients in the trial-eligible group. A very high risk (LVI+ or pN+ among the pT3-4 or ypT2-4) was significantly associated with poor prognosis.
A total of 52% of patients were eligible for adjuvant immunotherapy. Trial eligibility was significantly associated with a poor prognosis. LVI+ and pN+ may play a key role in candidate selection for adjuvant immunotherapy.
评估局部及局部晚期肌层浸润性膀胱癌（MIBC）和上尿路尿路上皮癌（UTUC）患者中，与辅助免疫治疗资格相关的术后病理结果对肿瘤学结局的影响。
我们回顾性评估了2000年1月至2021年4月期间接受根治性膀胱切除术（n = 597）和肾输尿管切除术（n = 485）的1082例患者。患者分为两组：未接受新辅助化疗的pT3 - 4或pN+，以及接受新辅助化疗的ypT2 - 4或pN+（符合试验条件组）或其他（不符合试验条件组）。主要结局是辅助免疫治疗的试验资格对无病生存期（DFS）和总生存期（OS）的影响。次要结局包括淋巴管侵犯（LVI）状态对临床试验标准预后的附加影响以及风险模型的建立。
MIBC组和UTUC组患者的中位年龄分别为69岁和72岁。52%的患者符合试验纳入标准。在MIBC和UTUC患者中，试验资格与较差的DFS和OS显著相关。在符合试验条件组的患者中，LVI阳性状态与较差的预后显著相关。极高风险（pT3 - 4或ypT2 - 4中的LVI+或pN+）与较差的预后显著相关。
共有52%的患者符合辅助免疫治疗的条件。试验资格与较差的预后显著相关。LVI+和pN+可能在辅助免疫治疗的候选者选择中起关键作用。
