Hatakeyama Shingo, Fujita Naoki, Kobayashi Mizuki, Kandori Shuya, Ikarashi Daiki, Fukuhara Hiroki, Sato Takuma, Myoen Shingo, Uemura Motohide, Inoue Takamitsu, Oikawa Masaaki, Kaiho Yasuhiro, Miyazaki Jun, Kojima Yoshiyuki, Adachi Hisanobu, Ito Akihiro, Tsuchiya Norihiko, Obara Wataru, Nishiyama Hiroyuki, Habuchi Tomonori, Ohyama Chikara
Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Sci Rep. 2025 Jul 12;15(1):25247. doi: 10.1038/s41598-025-11319-w.
We investigated trends in the use of perioperative therapy and the efficacy of adjuvant immunotherapy on the prognosis of patients with muscle-invasive urothelial carcinoma (MIUC). The usage and trends in neoadjuvant and adjuvant therapy were examined, and the efficacy of adjuvant immunotherapy was assessed using propensity score-adjusted Cox multivariate analysis. We investigated 1383 patients with muscle-invasive bladder cancer and 1124 patients with upper tract urothelial carcinoma; 1095 (43.7%) patients received neoadjuvant therapy and 366 (14.6%) patients received adjuvant therapy. Adjuvant therapy usage rate increased from 30.3% before 2022 to 61% after 2022 in patients with pathological high-risk cancer (pT3-4, ypT2-4, or pN+). The adjuvant immunotherapy usage rate increased from 2.8% before 2022 to 67.5% after 2022. Sixty-three (18.9%) of the 334 patients with pathological high-risk cancer who were treated with adjuvant therapy were treated with adjuvant immunotherapy. The propensity score-adjusted Cox multivariate analysis showed that adjuvant immunotherapy significantly improved disease-free survival (Hazard ratios (HR) 0.39, P < 0.005) and overall survival (HR 0.20, P < 0.005) compared with conventional adjuvant chemotherapy. In conclusion, the introduction of adjuvant immunotherapy led to the increased use of adjuvant therapy and improved prognoses in patients with MIUC in real-world practice.
我们研究了围手术期治疗的使用趋势以及辅助免疫疗法对肌层浸润性尿路上皮癌（MIUC）患者预后的疗效。我们检查了新辅助治疗和辅助治疗的使用情况及趋势，并使用倾向评分调整的Cox多变量分析评估了辅助免疫疗法的疗效。我们调查了1383例肌层浸润性膀胱癌患者和1124例上尿路尿路上皮癌患者；1095例（43.7%）患者接受了新辅助治疗，366例（14.6%）患者接受了辅助治疗。在病理高危癌症（pT3 - 4、ypT2 - 4或pN +）患者中，辅助治疗使用率从2022年前的30.3%增至2022年后的61%。辅助免疫疗法使用率从2022年前的2.8%增至2022年后的67.5%。在接受辅助治疗的334例病理高危癌症患者中，63例（18.9%）接受了辅助免疫疗法。倾向评分调整的Cox多变量分析显示，与传统辅助化疗相比，辅助免疫疗法显著改善了无病生存期（风险比（HR）0.39，P < 0.005）和总生存期（HR 0.20，P < 0.005）。总之，在实际临床实践中，辅助免疫疗法的引入导致辅助治疗的使用增加，并改善了MIUC患者的预后。
