Wakamiya Takahito, Yamashita Shimpei, Kohjimoto Yasuo, Hara Isao
Department of Urology, Wakayama Medical University, Wakayama, Japan.
Int J Urol. 2025 Aug;32(8):997-1004. doi: 10.1111/iju.70086. Epub 2025 May 6.
We investigate the association between serum lactate dehydrogenase and prognosis in patients with urothelial carcinoma who were treated with avelumab maintenance therapy in combination with other biomarkers.
We identified 54 patients with advanced or metastatic urothelial carcinoma that received avelumab maintenance therapy between June 2021 and February 2024 at our institutions. We retrospectively analyzed progression-free survival and overall survival from the initiation of avelumab maintenance therapy. Best overall response was evaluated based on the RECIST guidelines v1.1. To investigate factors potentially associated with response to avelumab maintenance therapy and overall survival, we conducted an assessment of markers that have been previously reported as prognostic factors, including urothelial carcinoma and other cancers.
The median overall survival by best overall response of first-line chemotherapy was not reached for complete response, partial response, or 15-month stable disease (p = 0.27). As for avelumab maintenance therapy, median overall survival by best overall response was not reached for complete response, partial response, and not evaluable; it was 18 months for stable disease and 13 months for progressive disease, with significant differences (p = 0.04). In multivariable analysis, lactate dehydrogenase level below the upper limit of normal prior to first-line chemotherapy was a significant independent factor in predicting disease control rate (p < 0.01) and overall survival (p = 0.04) in avelumab maintenance therapy.
Normal serum lactate dehydrogenase level prior to first-line chemotherapy was a significant predictor of favorable response or prognosis for avelumab maintenance therapy in our cohort.
我们研究接受阿维鲁单抗维持治疗的尿路上皮癌患者血清乳酸脱氢酶与预后之间的关联，并结合其他生物标志物进行分析。
我们纳入了2021年6月至2024年2月期间在我们机构接受阿维鲁单抗维持治疗的54例晚期或转移性尿路上皮癌患者。我们回顾性分析了从阿维鲁单抗维持治疗开始后的无进展生存期和总生存期。根据RECIST v1.1指南评估最佳总体缓解情况。为了研究可能与阿维鲁单抗维持治疗反应和总生存期相关的因素，我们对先前已报道为预后因素的标志物进行了评估，包括尿路上皮癌和其他癌症。
一线化疗的最佳总体缓解为完全缓解、部分缓解或15个月疾病稳定时，未达到中位总生存期（p = 0.27）。对于阿维鲁单抗维持治疗，最佳总体缓解为完全缓解、部分缓解且不可评估时，未达到中位总生存期；疾病稳定时为18个月，疾病进展时为13个月，差异有统计学意义（p = 0.04）。在多变量分析中，一线化疗前乳酸脱氢酶水平低于正常上限是预测阿维鲁单抗维持治疗疾病控制率（p < 0.01）和总生存期（p = 0.04）的显著独立因素。
在我们的队列中，一线化疗前血清乳酸脱氢酶水平正常是阿维鲁单抗维持治疗良好反应或预后的显著预测指标。
