结合血清炎症标志物和临床因素预测接受免疫检查点抑制剂治疗的转移性尿路上皮癌患者的生存率。
Combining serum inflammatory markers and clinical factors to predict survival in metastatic urothelial carcinoma patients treated with immune checkpoint inhibitors.
作者信息
Cheng Liang-Yun, Su Po-Jung, Kuo Ming-Chun, Lin Chang-Ting, Luo Hao-Lun, Chou Chih-Chi, Huang Shih-Yu, Wu Chia-Che, Chen Chien-Hsu, Huang Chun-Chieh, Tsai Kai-Lung, Yu-Li Su Harvey
机构信息
Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan.
出版信息
Ther Adv Med Oncol. 2024 Dec 15;16:17588359241305091. doi: 10.1177/17588359241305091. eCollection 2024.
BACKGROUND
Despite the revolutionary impact of immune checkpoint inhibitors (ICIs) on the treatment of metastatic urothelial carcinoma (mUC), the clinical utility of reliable prognostic biomarkers to foresee survival outcomes remains underexplored.
OBJECTIVES
The purpose of this study was to ascertain the prognostic significance of serum inflammatory markers in mUC patients undergoing ICI therapy.
DESIGN
This is a retrospective, multicenter study.
METHODS
Data were collected from two independent medical centers in Taiwan, encompassing a validation and a training cohort (TC). Patients with histopathologically confirmed urothelial carcinoma who received at least one cycle of ICI monotherapy were included. Serum inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated prior to ICI therapy. Statistical analyses involved the use of receiver operating characteristic (ROC) curves to determine optimal biomarker cutoffs and Cox proportional hazards models to evaluate the independent predictive capability of these markers.
RESULTS
A total of 192 patients were enrolled. In the univariate analysis, serum markers such as NLR, PLR, SII, and Hb were significantly associated with overall survival (OS) in both the training and validation cohorts (VC). White blood cells, NLR, and SII demonstrated a robust correlation with progression-free survival across both cohorts. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status ⩾2 ( < 0.001), visceral metastasis ( < 0.001), leukocytosis ( < 0.001), Hb levels ⩾10 mg/dL ( = 0.008), and NLR ⩾5 ( = 0.032) as independent predictors of OS. A prognostic nomogram integrating these independent factors yielded a C-index for a 3-year OS of 0.769 in the TC and 0.657 in the VC.
CONCLUSION
Serum inflammatory markers, combined with clinicopathologic factors, provide a practical prognostic tool in mUC treatment with ICIs.
背景
尽管免疫检查点抑制剂（ICI）对转移性尿路上皮癌（mUC）的治疗产生了革命性影响，但用于预测生存结果的可靠预后生物标志物的临床实用性仍未得到充分探索。
目的
本研究旨在确定血清炎症标志物在接受ICI治疗的mUC患者中的预后意义。
设计
这是一项回顾性多中心研究。
方法
从台湾的两个独立医疗中心收集数据，包括一个验证队列和一个训练队列（TC）。纳入经组织病理学确诊为尿路上皮癌且接受至少一个周期ICI单药治疗的患者。在ICI治疗前计算血清炎症标志物，如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII）。统计分析包括使用受试者工作特征（ROC）曲线确定最佳生物标志物临界值，并使用Cox比例风险模型评估这些标志物的独立预测能力。
结果
共纳入192例患者。在单变量分析中，血清标志物如NLR、PLR、SII和血红蛋白（Hb）在训练队列和验证队列（VC）中均与总生存期（OS）显著相关。白细胞、NLR和SII在两个队列中均与无进展生存期密切相关。多变量分析显示，东部肿瘤协作组（ECOG）体能状态⩾2（<0.001）、内脏转移（<0.001）、白细胞增多（<0.001）、Hb水平⩾10mg/dL（=0.008）和NLR⩾5（=0.032）是OS的独立预测因素。整合这些独立因素的预后列线图在TC中3年OS的C指数为0.769，在VC中为0.657。
结论
血清炎症标志物与临床病理因素相结合，为mUC的ICI治疗提供了一种实用的预后工具。
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