Kurashina Ryo, Ando Kiyohiro, Inoue Masaharu, Maruyama Riko, Mitani Kouki, Takenobu Hisanori, Haruta Masayuki, Onuki Ritsuko, Matsuoka Yoh, Kamijo Takehiko, Kageyama Yukio
Department of Urology, Saitama Cancer Center, Saitama, Japan.
Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan.
Cancer Diagn Progn. 2023 Mar 3;3(2):230-235. doi: 10.21873/cdp.10206. eCollection 2023 Mar-Apr.
BACKGROUND/AIM: Several prognostic risk factors have been recognized when using cisplatin-based conventional chemotherapy for the treatment of advanced urothelial carcinoma (UC); these include performance status (PS), liver metastasis, hemoglobin (Hb) levels, time from prior chemotherapy (TFPC), and other systemic inflammation scores including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). However, the benefit of these indicators for predicting outcome of immune checkpoint inhibitors is not fully understood. Here, we investigated the predictive value of the indicators in patients who received pembrolizumab for the treatment of advanced UC.
Seventy-five patients who received pembrolizumab treatment for advanced UC were included. The Karnofsky PS, liver metastasis, hemoglobin levels, TFPC, NLR, and PLR were analyzed, and their relationship with overall survival (OS) was determined.
All factors were highlighted as significant prognostic indicators for OS in the univariate proportional regression analysis (p<0.05 for each). Multivariate analysis revealed that Karnofsky PS and liver metastasis were independent prognostic indicators for OS (p<0.01) but were applicable only for a small number of patients. Notably, the combined analysis with low Hb levels and high PLR was significantly associated with OS in patients who could gain less benefit from pembrolizumab at a median of 6.6 [95% confidence interval (CI)=4.2-9.0] versus 15.1 (95% CI=12.4-17.8) months (p=0.002).
The combination of Hb levels and PLR may be a broadly applicable indicator for the outcome of pembrolizumab as second-line chemotherapy in patients with advanced UC.
背景/目的：在使用基于顺铂的传统化疗治疗晚期尿路上皮癌（UC）时，已经识别出多个预后风险因素；这些因素包括体能状态（PS）、肝转移、血红蛋白（Hb）水平、距上次化疗的时间（TFPC），以及其他全身炎症评分，包括中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。然而，这些指标对免疫检查点抑制剂治疗结局的预测价值尚未完全明确。在此，我们研究了这些指标在接受派姆单抗治疗晚期UC患者中的预测价值。
纳入75例接受派姆单抗治疗晚期UC的患者。分析了卡诺夫斯基PS、肝转移、血红蛋白水平、TFPC、NLR和PLR，并确定了它们与总生存期（OS）的关系。
在单变量比例回归分析中，所有因素均被视为OS的显著预后指标（各因素p<0.05）。多变量分析显示，卡诺夫斯基PS和肝转移是OS的独立预后指标（p<0.01），但仅适用于少数患者。值得注意的是，在接受派姆单抗治疗获益较少的患者中，低Hb水平和高PLR的联合分析与OS显著相关，中位OS分别为6.6[95%置信区间（CI）=4.2-9.0]个月和15.1（95%CI=12.4-17.8）个月（p=0.002）。
Hb水平和PLR的联合可能是晚期UC患者接受派姆单抗作为二线化疗结局的一个广泛适用的指标。
