Oncology Unit 1, Istituto Oncologico Veneto, IOV - IRCCS, Padua, Italy.
Oncology Unit, AULSS6 Euganea, Ospedali Riuniti Padova Sud, Monselice, Italy.
Anticancer Res. 2024 Oct;44(10):4379-4386. doi: 10.21873/anticanres.17267.
BACKGROUND/AIM: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic urothelial carcinoma (mUC). However, they could be associated with immune-related adverse events (irAEs), which may be clinically significant. Identifying clinical characteristics that may be associated with a higher risk of irAEs is of great importance.
We retrospectively collected data from all patients who received anti-PD1 or anti-PD-L1 for metastatic UC at our Institution from January 2017 to December 2022. Patients were dichotomized according to baseline neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and platelet-to-lymphocyte ratio (PLR) values. We performed univariate and multivariate logistic regression to determine the association between baseline characteristics and the development of irAEs.
A total of 119 patients were identified. At a median follow-up of 29.6 months, 96 patients progressed and 82 died. Forty-five patients developed irAEs of any grade, 8 patients developed grade 3 toxicities. In the univariate analysis PS of 0 (p<0.01), baseline NLR <3.52, baseline PLR <194 (p=0.04) and baseline SII <906 (p=0.01) were significantly associated with a higher risk of developing irAEs, whereas in the multivariate analysis only PS=0 (p<0.01) and NLR <3.52 (p=0.03) maintained their correlation. Median progression-free survival (mPFS) and overall survival (mOS) were significantly longer in patients with NLR <3 (mPFS 3.8 vs. 2.6 months, p=0.01; mOS 15.3 vs. 5.6 months, p=0.002) and PS=0 (mPFS 4.8 vs. 2.1 months, p<0.001; mOS 15.3 vs. 3.8 months, p<0.001).
Low baseline NLR, PLR, and SII and good PS are associated with a higher risk of developing irAEs in patients treated with ICIs for mUC.
背景/目的：免疫检查点抑制剂 (ICIs) 彻底改变了转移性尿路上皮癌 (mUC) 的治疗方法。然而，它们可能与免疫相关的不良反应 (irAE) 相关，这些不良反应可能具有临床意义。确定可能与更高 irAE 风险相关的临床特征非常重要。
我们回顾性地收集了自 2017 年 1 月至 2022 年 12 月在我院接受抗 PD-1 或抗 PD-L1 治疗的转移性 UC 患者的所有数据。根据基线中性粒细胞与淋巴细胞比值 (NLR)、全身免疫炎症指数 (SII) 和血小板与淋巴细胞比值 (PLR) 值，患者分为两组。我们进行了单变量和多变量逻辑回归分析，以确定基线特征与 irAE 发生之间的关联。
共纳入 119 例患者。中位随访 29.6 个月时，96 例患者进展，82 例患者死亡。45 例患者发生任何等级的 irAE，8 例患者发生 3 级毒性。在单变量分析中，PS 为 0(p<0.01)、基线 NLR<3.52、基线 PLR<194(p=0.04)和基线 SII<906(p=0.01)与发生 irAE 的风险较高显著相关，而在多变量分析中，只有 PS=0(p<0.01)和 NLR<3.52(p=0.03)仍然存在相关性。NLR<3 组的中位无进展生存期 (mPFS) 和总生存期 (mOS) 明显长于 NLR≥3 组(mPFS 3.8 个月 vs. 2.6 个月，p=0.01；mOS 15.3 个月 vs. 5.6 个月，p=0.002)，PS=0 组的 mPFS 和 mOS 明显长于 PS>0 组(mPFS 4.8 个月 vs. 2.1 个月，p<0.001；mOS 15.3 个月 vs. 3.8 个月，p<0.001)。
低基线 NLR、PLR 和 SII 以及良好的 PS 与接受 ICIs 治疗的 mUC 患者发生 irAE 的风险较高相关。
