Széles Ádám, Kubik András, Váncsa Szilárd, Grünwald Viktor, Hadaschik Boris, Ács Nándor, Hegyi Péter, Nyirády Péter, Szarvas Tibor
Department of Urology, Semmelweis University, Budapest, Hungary.
Center for Translational Medicine, Semmelweis University, Budapest, Hungary.
Front Immunol. 2025 Mar 17;16:1554048. doi: 10.3389/fimmu.2025.1554048. eCollection 2025.
The therapeutic landscape of locally advanced or metastatic urothelial carcinoma (mUC) is rapidly evolving, and immune checkpoint inhibitors (ICI) have become an integral part of the standard therapy. However, the majority of patients do not benefit from this treatment. Hence, finding prognostic and predictive biomarkers may improve therapeutic decision-making. The aim of this study was to analyze the prognostic and predictive significance of liquid biomarkers (NLR, CRP, PLR, and LDH) in mUC patients treated with ICI.
We collected articles from PubMed, Cochrane, and Embase databases with primary outcomes of overall survival (OS), progression-free survival (PFS) and objective response rate (ORR).
We compiled data from a total of 6,673 ICI-treated patients with locally advanced or mUC from 31 articles. Pooled univariate analysis demonstrated that high pre-treatment NLR is significantly associated with worse OS (HR: 2.19; 95% CI: 1.80-2.68) and PFS (HR: 1.90; 95% CI: 1.57-2.31). Similarly, elevated CRP levels were associated with worse OS (HR: 1.75; 95% CI: 1.37-2.24) and PFS (HR: 1.58; 95% CI: 1.26-1.99).
Elevated pre-treatment NLR, CRP, PLR, and LDH are significantly associated with worse OS and PFS in ICI-treated urothelial carcinoma patients, suggesting that they have potential prognostic and predictive value in treatment decisions.
In this systematic review and meta-analysis we summarized the existing data on inflammatory laboratory biomarkers and their potential impact on immunotherapy outcomes in urothelial cancers.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022291449.
局部晚期或转移性尿路上皮癌（mUC）的治疗格局正在迅速演变，免疫检查点抑制剂（ICI）已成为标准治疗的重要组成部分。然而，大多数患者并未从这种治疗中获益。因此，寻找预后和预测生物标志物可能会改善治疗决策。本研究的目的是分析液体生物标志物（中性粒细胞与淋巴细胞比值（NLR）、C反应蛋白（CRP）、血小板与淋巴细胞比值（PLR）和乳酸脱氢酶（LDH））在接受ICI治疗的mUC患者中的预后和预测意义。
我们从PubMed、Cochrane和Embase数据库收集了以总生存期（OS）、无进展生存期（PFS）和客观缓解率（ORR）为主要结局的文章。
我们汇总了来自31篇文章的总共6673例接受ICI治疗的局部晚期或mUC患者的数据。汇总的单因素分析表明，治疗前高NLR与较差的OS（风险比（HR）：2.19；95%置信区间（CI）：1.80 - 2.68）和PFS（HR：1.90；95% CI：1.57 - 2.31）显著相关。同样，CRP水平升高与较差的OS（HR：1.75；95% CI：1.37 - 2.24）和PFS（HR：1.58；95% CI：1.26 - 1.99）相关。
治疗前升高的NLR、CRP、PLR和LDH与接受ICI治疗的尿路上皮癌患者较差的OS和PFS显著相关，表明它们在治疗决策中具有潜在的预后和预测价值。
在本系统评价和荟萃分析中，我们总结了关于炎症实验室生物标志物及其对尿路上皮癌免疫治疗结局潜在影响的现有数据。
