Kobayashi Keita, Sakano Shigeru, Matsumoto Hiroaki, Yamamoto Mitsutaka, Tsuchida Masahiro, Tei Yasuhide, Nagao Kazuhiro, Oba Kazuo, Kitahara Seiji, Yano Seiji, Yoshihiro Satoru, Yamamoto Yoshiaki, Ohmi Chietaka, Komatsu Hirotaka, Misumi Taku, Akao Jumpei, Shiraishi Koji
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
Department of Urology, Kokura Memorial Hospital, Kitakyushu, Japan.
Jpn J Clin Oncol. 2025 Feb 4;55(2):148-157. doi: 10.1093/jjco/hyae137.
Avelumab and pembrolizumab are administered after platinum-based chemotherapy for the treatment of metastatic urothelial carcinoma. We explored the prognostic factors and risk scores for predicting the outcomes of metastatic or unresectable urothelial carcinoma at the start of treatment with immune checkpoint inhibitors.
This retrospective study included patients with metastatic or unresectable urothelial carcinoma treated with avelumab or pembrolizumab after platinum-based chemotherapy between January 2017 and December 2022. Prognostic factors, including patient and tumor characteristics and blood data at the initiation of immune checkpoint inhibitor therapy, were examined.
This study included 36 and 207 patients treated with avelumab and pembrolizumab, respectively, for metastatic or unresectable urothelial carcinoma. Eastern Cooperative Oncology Group performance status, presence of visceral metastases, platelet-to-lymphocyte ratio and lactate dehydrogenase levels were independent prognostic factors for predicting overall survival. The median overall survival of patients in the risk-score model was 58.5 months (score zero), 27.9 months (one), 13.1 months (two) and 3.9 months (three or higher). The C-index for overall survival was 0.718 for the newly developed risk score compared with 0.679 for the Bellmunt score and 0.703 for the Bellmunt-C-reactive protein score. Additionally, the C-index for overall survival using the immune prognostic index derived from lactate dehydrogenase and the platelet-to-lymphocyte ratio was 0.646 compared with 0.615 for the Lung Immune Prognostic Index.
A risk score that includes the platelet-to-lymphocyte ratio and lactate dehydrogenase may serve as a useful model for predicting prognosis following the initiation of immune checkpoint inhibitors in patients with metastatic or unresectable urothelial carcinoma.
阿维鲁单抗和帕博利珠单抗在铂类化疗后用于治疗转移性尿路上皮癌。我们探讨了在免疫检查点抑制剂治疗开始时预测转移性或不可切除性尿路上皮癌预后的因素和风险评分。
这项回顾性研究纳入了2017年1月至2022年12月期间在铂类化疗后接受阿维鲁单抗或帕博利珠单抗治疗的转移性或不可切除性尿路上皮癌患者。研究了包括患者和肿瘤特征以及免疫检查点抑制剂治疗开始时的血液数据等预后因素。
本研究分别纳入了36例和207例接受阿维鲁单抗和帕博利珠单抗治疗转移性或不可切除性尿路上皮癌的患者。东部肿瘤协作组体能状态、内脏转移情况、血小板与淋巴细胞比值和乳酸脱氢酶水平是预测总生存期的独立预后因素。风险评分模型中患者的中位总生存期分别为58.5个月（评分为零）、27.9个月（评分为一）、13.1个月（评分为二）和3.9个月（评分为三或更高）。新开发的风险评分的总生存期C指数为0.718，而贝尔蒙特评分的C指数为0.679，贝尔蒙特 - C反应蛋白评分的C指数为0.703。此外，使用由乳酸脱氢酶和血小板与淋巴细胞比值得出的免疫预后指数的总生存期C指数为0.646，而肺免疫预后指数的C指数为0.615。
包含血小板与淋巴细胞比值和乳酸脱氢酶的风险评分可能是预测转移性或不可切除性尿路上皮癌患者免疫检查点抑制剂治疗开始后预后的有用模型。
