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基于人工智能的尿路上皮癌术后辅助免疫治疗获益的多模态预测:III期、多中心、随机、IMvigor010试验的结果

Artificial Intelligence-Based Multimodal Prediction of Postoperative Adjuvant Immunotherapy Benefit in Urothelial Carcinoma: Results From the Phase III, Multicenter, Randomized, IMvigor010 Trial.

作者信息

Huang Xiatong, Qiu Wenjun, Kong Yuyun, Ou Qiyun, Mao Qianqian, Fang Yiran, Fan Zhouyang, Wu Jiani, Lu Xiansheng, Gu Wenchao, Luo Peng, Wang Junfen, Bin Jianping, Liao Yulin, Shi Min, Wu Zuqiang, Sun Huiying, Yu Yunfang, Liao Wangjun, Zeng Dongqiang

机构信息

Department of Oncology Nanfang Hospital Southern Medical University Guangzhou Guangdong China.

Cancer Center the Sixth Affiliated Hospital School of Medicine South China University of Technology Foshan China.

出版信息

MedComm (2020). 2025 Aug 25;6(9):e70324. doi: 10.1002/mco2.70324. eCollection 2025 Sep.


DOI:10.1002/mco2.70324
PMID:40859961
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12377507/
Abstract

While circulating tumor DNA (ctDNA) testing has demonstrated utility in identifying muscle-invasive urothelial carcinoma (MIUC) patients likely to benefit from adjuvant immunotherapy, the prognostic value of transcriptome data from surgical specimens remains underexplored. Using transcriptomic and ctDNA data from the IMvigor010 trial, we developed an artificial intelligence (AI)-driven biomarker to predict immunotherapy response in urothelial carcinoma, termed UAIscore. Patients with high UAIscore had significantly better outcomes in the atezolizumab arm versus the observation arm. Notably, the predictive performance of the UAIscore consistently outperformed that of ctDNA, tTMB, and PD-L1, highlighting its value as an independent biomarker. Moreover, combining ctDNA, tTMB, and PD-L1 with the UAIscore further improved predictive accuracy, underscoring the importance of integrating multi-modality biomarkers. Further analysis of molecular subtypes revealed that the luminal subtype tends to be sensitive to adjuvant immunotherapy, as it may exhibit the highest level of immune infiltration and the lowest degree of hypoxia. Remarkably, we elucidated the role of the NF-κB and TNF-α pathways in mediating immunotherapy resistance within the immune-enriched tumor microenvironment. These findings stratify patients likely to respond to adjuvant immunotherapy, concurrently providing a mechanistic rationale for combination therapies to augment immunotherapy efficacy in urothelial carcinoma.

摘要

虽然循环肿瘤DNA(ctDNA)检测已证明在识别可能从辅助免疫治疗中获益的肌层浸润性尿路上皮癌(MIUC)患者方面具有实用性,但手术标本转录组数据的预后价值仍未得到充分探索。利用IMvigor010试验的转录组和ctDNA数据,我们开发了一种人工智能(AI)驱动的生物标志物来预测尿路上皮癌的免疫治疗反应,称为UAIscore。UAIscore高的患者在阿替利珠单抗组的预后明显优于观察组。值得注意的是,UAIscore的预测性能始终优于ctDNA、肿瘤突变负荷(tTMB)和程序性死亡配体1(PD-L1),突出了其作为独立生物标志物的价值。此外,将ctDNA、tTMB和PD-L1与UAIscore相结合进一步提高了预测准确性,强调了整合多模态生物标志物的重要性。分子亚型的进一步分析显示,管腔亚型往往对辅助免疫治疗敏感,因为它可能表现出最高水平的免疫浸润和最低程度的缺氧。值得注意的是,我们阐明了核因子κB(NF-κB)和肿瘤坏死因子-α(TNF-α)通路在免疫丰富的肿瘤微环境中介导免疫治疗耐药性的作用。这些发现对可能对辅助免疫治疗有反应的患者进行了分层,同时为联合治疗增强尿路上皮癌免疫治疗疗效提供了机制依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/1a06fa650d4c/MCO2-6-e70324-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/52de631b11c9/MCO2-6-e70324-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/9ef5cc5bbfa7/MCO2-6-e70324-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/b7b7cd80747e/MCO2-6-e70324-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/250e1cb30648/MCO2-6-e70324-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/fc97116bc50f/MCO2-6-e70324-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/1a06fa650d4c/MCO2-6-e70324-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/52de631b11c9/MCO2-6-e70324-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/9ef5cc5bbfa7/MCO2-6-e70324-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/b7b7cd80747e/MCO2-6-e70324-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/250e1cb30648/MCO2-6-e70324-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/fc97116bc50f/MCO2-6-e70324-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3228/12377507/1a06fa650d4c/MCO2-6-e70324-g006.jpg

相似文献

[1]
Artificial Intelligence-Based Multimodal Prediction of Postoperative Adjuvant Immunotherapy Benefit in Urothelial Carcinoma: Results From the Phase III, Multicenter, Randomized, IMvigor010 Trial.

MedComm (2020). 2025-8-25

[2]
Circulating tumor DNA as a Predictive and Prognostic Biomarker in the Perioperative Treatment of Muscle-invasive Bladder Cancer: A Systematic Review.

Eur Urol Oncol. 2024-2

[3]
Interplay between tumor mutation burden and the tumor microenvironment predicts the prognosis of pan-cancer anti-PD-1/PD-L1 therapy.

Front Immunol. 2025-7-24

[4]
Can a Liquid Biopsy Detect Circulating Tumor DNA With Low-passage Whole-genome Sequencing in Patients With a Sarcoma? A Pilot Evaluation.

Clin Orthop Relat Res. 2025-1-1

[5]
Surveillance of the Genetic Signature in Circulating Tumor DNA for Guiding Adjuvant Chemotherapy in Urothelial Carcinoma: Protocol for a Pilot Randomized Controlled Trial.

JMIR Res Protoc. 2025-8-26

[6]
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Health Technol Assess. 2006-9

[7]
Prescription of Controlled Substances: Benefits and Risks

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[8]
ctDNA-guided adjuvant immunotherapy in colorectal cancer.

Immunotherapy. 2024

[9]
Adjuvant immunotherapy in patients with high-risk muscle-invasive urothelial carcinoma: The potential impact of informative censoring.

Cancer. 2022-8-1

[10]
Immunotherapy for advanced or metastatic urothelial carcinoma.

Cochrane Database Syst Rev. 2023-10-9

本文引用的文献

[1]
Enhancing immuno-oncology investigations through multidimensional decoding of tumor microenvironment with IOBR 2.0.

Cell Rep Methods. 2024-12-16

[2]
SERPINB5 promotes colorectal cancer invasion and migration by promoting EMT and angiogenesis via the TNF-α/NF-κB pathway.

Int Immunopharmacol. 2024-4-20

[3]
NF-κB in biology and targeted therapy: new insights and translational implications.

Signal Transduct Target Ther. 2024-3-4

[4]
Infliximab, a Monoclonal Antibody against TNF-α, Inhibits NF-κB Activation, Autotaxin Expression and Breast Cancer Metastasis to Lungs.

Cancers (Basel). 2023-12-21

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TNF-α induced NF-κB mediated LYRM7 expression modulates the tumor growth and metastatic ability in breast cancer.

Free Radic Biol Med. 2024-2-1

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Ann Oncol. 2024-1

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Tumor aerobic glycolysis confers immune evasion through modulating sensitivity to T cell-mediated bystander killing via TNF-α.

Cell Metab. 2023-9-5

[9]
Collagen architecture and signaling orchestrate cancer development.

Trends Cancer. 2023-9

[10]
Teasing out missing reactions in genome-scale metabolic networks through hypergraph learning.

Nat Commun. 2023-4-25

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