Laukhtina Ekaterina, Hassler Melanie R, Pradere Benjamin, Yanagisawa Takafumi, Quhal Fahad, Rajwa Pawel, Sari Motlagh Reza, König Frederik, Pallauf Maximilian, Kawada Tatsushi, Mostafaei Hadi, D'Andrea David, Enikeev Dmitry, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Eur Urol Focus. 2022 Nov;8(6):1683-1686. doi: 10.1016/j.euf.2022.04.017. Epub 2022 May 11.
We summarise the available data for and assess the prognostic value of circulating tumour DNA (ctDNA) in patients treated with systemic therapy for urothelial carcinoma (UC). Studies were deemed eligible if they reported on oncologic outcomes for patients with UC treated with systemic therapy according to the baseline ctDNA profile (before starting systemic therapy) and/or changes over the course of therapy. Five studies met the eligibility criteria. We found a strong association between high baseline ctDNA levels and worse disease-free survival (DFS; hazard ratio [HR] 3.53, 95% confidence interval [CI] 2.58-4.84) and overall survival (OS; HR 2.99, 95% CI 2.17-4.13). Patients with a decline in ctDNA level after immunotherapy had better DFS (HR 0.25, 95% CI 0.13-0.49) and OS (HR 0.10, 95% CI 0.03-0.42) in comparison to patients without a ctDNA decline. Conversely, an increase in ctDNA levels after immunotherapy was associated with worse survival outcomes. Patients with UC who exhibited a decrease in ctDNA levels during systemic therapy had better survival outcomes compared to those with stable or increasing ctDNA levels. PATIENT SUMMARY: Measurement of tumour DNA in blood may help in identifying patients with cancer of the urinary tract who are unlikely to respond to chemotherapy or immunotherapy. This could serve as a biomarker for monitoring cancer treatment.
我们总结了接受全身治疗的尿路上皮癌（UC）患者循环肿瘤DNA（ctDNA）的现有数据，并评估了其预后价值。如果研究报告了根据基线ctDNA谱（开始全身治疗前）和/或治疗过程中的变化接受全身治疗的UC患者的肿瘤学结局，则这些研究被视为合格。五项研究符合纳入标准。我们发现基线ctDNA水平高与无病生存期（DFS；风险比[HR] 3.53，95%置信区间[CI] 2.58 - 4.84）和总生存期（OS；HR 2.99，95% CI 2.17 - 4.13）较差之间存在密切关联。与ctDNA水平未下降的患者相比，免疫治疗后ctDNA水平下降的患者DFS（HR 0.25，95% CI 0.13 - 0.49）和OS（HR 0.10，95% CI 0.03 - 0.42）更好。相反，免疫治疗后ctDNA水平升高与较差的生存结局相关。与ctDNA水平稳定或升高的患者相比，全身治疗期间ctDNA水平下降的UC患者生存结局更好。患者总结：血液中肿瘤DNA的检测可能有助于识别对化疗或免疫治疗无反应的尿路癌症患者。这可作为监测癌症治疗的生物标志物。
