Parent Pauline, Auclin Edouard, Patrikidou Anna, Mezquita Laura, Martínez Chanzá Nieves, Dumont Clément, Rodriguez-Vida Alejo, Llacer Casilda, Lozano Rebeca, Ratta Raffaele, Merseburger Axel S, Sternberg Cora N, Baciarello Giulia, Colomba Emeline, Fuerea Alina, Besse Benjamin, Loriot Yohann, Lavaud Pernelle
Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
Department of Oncology Medical, CHU Lille, 2 Av. Oscar Lambret, 59000 Lille, France.
Cancers (Basel). 2023 Feb 7;15(4):1066. doi: 10.3390/cancers15041066.
Few prognostic factors have been identified in patients with metastatic urothelial carcinoma (mUC) treated with immune checkpoint inhibitors (ICIs). The Lung Immune Prognostic Index (LIPI) was associated with clinical outcomes for ICIs in several tumor types. We aim to assess the value of the LIPI in patients with mUC treated with ICIs. A retrospective ICI cohort and a validation cohort (SAUL cohort) included, respectively, patients with mUC treated with ICI in 8 European centers (any line) and patients treated with atezolizumab in a second or further line. A chemotherapy-only cohort was also analyzed. The LIPI score was based on 2 factors, derived neutrophils/(leukocytes minus neutrophils) ratio (dNLR) > 3 and lactate dehydrogenase > upper limit of normal, and defined 3 prognostic groups. The association of LIPI with progression-free survival (PFS) and overall survival (OS) was assessed. In the ICI and SAUL cohorts, 137 and 541 patients were respectively analyzed. In the ICI cohort, mPFS and mOS were 3.6 mo (95% CI; 2.6-6.0) and 13.8 mo (95% CI; 11.5-23.2) whereas in the SAUL cohort the mPFS and mOS were 2.2 mo (95% CI; 2.1-2.3) and 8.7 mo (95% CI; 7.8-9.9) respectively. The LIPI classified the population of these cohorts in good (56%; 52%), intermediate (35%; 36%) and poor (9%; 12%) prognostic groups (values for the ICI and SAUL cohorts respectively). Poor LIPI was associated with a poorer OS in both cohorts: hazard ratio (HR) for the ICI cohort = 2.69 (95% CI; 1.24-5.84, = 0.035); HR = 2. 89 for the SAUL cohort (CI 95%: 1.93-4.32, < 0.0001). Similar results were found in the chemo cohort. The LIPI score allows to identify different subgroups in patients with good prognostis according to the Bellmunt score criteria, with a subset of patients with poorer outcomes having an mOS of 3.7 mo compared to the good and intermediate LIPI subgroups with mOS of 17.9 and 7.4 mo, respectively. The LIPI score was associated with survival in mUC patients treated by ICIs. Future prospective studies will be required to test the combination of Bellmunt score and the LIPI score as a more accurate prognosis tool.
在接受免疫检查点抑制剂（ICI）治疗的转移性尿路上皮癌（mUC）患者中，已确定的预后因素很少。肺免疫预后指数（LIPI）与几种肿瘤类型中ICI的临床结果相关。我们旨在评估LIPI在接受ICI治疗的mUC患者中的价值。一项回顾性ICI队列和一个验证队列（SAUL队列）分别纳入了8个欧洲中心接受ICI治疗的mUC患者（任何治疗线）和接受阿替利珠单抗二线或后续治疗线的患者。还分析了仅接受化疗的队列。LIPI评分基于两个因素，即衍生中性粒细胞/（白细胞减去中性粒细胞）比值（dNLR）>3和乳酸脱氢酶>正常上限，并定义了3个预后组。评估了LIPI与无进展生存期（PFS）和总生存期（OS）的相关性。在ICI和SAUL队列中，分别分析了137例和541例患者。在ICI队列中，中位PFS和中位OS分别为3.6个月（95%CI；2.6 - 6.0）和13.8个月（95%CI；11.5 - 23.2），而在SAUL队列中，中位PFS和中位OS分别为2.2个月（95%CI；2.1 - 2.3）和8.7个月（95%CI；7.8 - 9.9）。LIPI将这些队列中的人群分为预后良好（56%；52%）、中等（35%；36%）和不良（9%；12%）组（分别为ICI和SAUL队列的值）。在两个队列中，LIPI不良均与较差的OS相关：ICI队列的风险比（HR）=2.69（95%CI；1.24 - 5.84，P = 0.035）；SAUL队列的HR = 2.89（95%CI：1.93 - 4.32，P < 0.0001）。在化疗队列中也发现了类似结果。根据Bellmunt评分标准，LIPI评分能够识别预后良好患者中的不同亚组，与LIPI良好和中等亚组的中位OS分别为17.9个月和7.4个月相比，有一部分预后较差的患者中位OS为3.7个月。LIPI评分与接受ICI治疗的mUC患者的生存期相关。未来需要进行前瞻性研究，以测试将Bellmunt评分和LIPI评分相结合作为更准确的预后工具。
