Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
Jpn J Clin Oncol. 2024 Mar 9;54(3):254-264. doi: 10.1093/jjco/hyad172.
The management of advanced (locally advanced or metastatic) urothelial carcinoma has been revolutionized since pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial carcinoma treated with pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver) metastasis, laboratory markers such as the neutrophil-to-lymphocyte ratio, sarcopenia, histological/genomic markers such as programmed cell death ligand 1 immunohistochemistry and tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary tumor site (bladder cancer versus upper tract urothelial carcinoma) and history/combination of radiotherapy. The survival time of advanced urothelial carcinoma has been significantly prolonged (or 'doubled' from 1 to 2 years) after the advent of pembrolizumab, which will be further improved with novel agents such as avelumab and enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the contemporary era of immune checkpoint inhibitors.
自 2017 年帕博利珠单抗问世以来，晚期（局部晚期或转移性）尿路上皮癌的治疗管理发生了革命性变化。已经报道了几种用帕博利珠单抗治疗的晚期尿路上皮癌的预后因素，包括常规参数，如体能状态和内脏（尤其是肝脏）转移、实验室标志物，如中性粒细胞与淋巴细胞比值、肌肉减少症、组织学/基因组标志物，如程序性死亡配体 1 免疫组化和肿瘤突变负担、变异组织学、免疫相关不良反应、与肠道微生物组相关的伴随药物、原发肿瘤部位（膀胱癌与上尿路尿路上皮癌）和放疗史/联合治疗。帕博利珠单抗问世后，晚期尿路上皮癌的生存时间显著延长（从 1 年延长至 2 年，“翻倍”），随着avelumab 和 enfortumab vedotin 等新型药物的出现，这一结果将进一步改善。这篇综述总结了免疫检查点抑制剂时代晚期尿路上皮癌的最新临床结局和预后因素的证据。
