Role of a Modified Urothelium Immune Prognostic Index in Patients With Metastatic Urothelial Carcinoma Treated With Anti-PD-1/PD-L1-Based Therapy.
Role of a Modified Urothelium Immune Prognostic Index in Patients With Metastatic Urothelial Carcinoma Treated With Anti-PD-1/PD-L1-Based Therapy.
复制标题
改良尿路上皮免疫预后指数在接受抗 PD-1/PD-L1 治疗的转移性尿路上皮癌患者中的作用
DOI：
10.3389/fmolb.2021.621883
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发表时间：
2021
影响因子：
5
通讯作者：
Shi Y
中科院分区：
文献类型：
--
作者：
Li H;An X;Huang R;Li L;Chu C;Yang W;Qin Z;Liu Z;Zhou F;Xue C;Shi Y
引言：程序性死亡受体 -1（PD -1）及其配体（PD -L1）抗体的使用提高了转移性尿路上皮癌（mUC）患者的生存率。然而，仍然缺乏可靠且便捷的早期反应和预后生物标志物。
材料与方法：我们回顾性筛选了在我院接受基于抗PD -1/PD -L1治疗的mUC患者。基于中性粒细胞与淋巴细胞比值（NLR）和乳酸脱氢酶（LDH）建立了一种改良的尿路上皮免疫预后指数（mUIPI），将患者分为mUIPI良好、中等和不良三组。主要观察指标为无进展生存期（PFS）、总生存期（OS）和疾病控制率（DCR）。
结果：我们确定了52例mUC患者，中位随访时间为29.8个月（95%置信区间，26.3 - 53.2）。低NLR与改善的PFS和OS相关（风险比[HR]分别为0.40，95%置信区间，0.18 - 0.92；HR为0.27，95%置信区间，0.11 - 0.69）。正常LDH与改善的PFS相关，但与OS无关（HR分别为0.22，95%置信区间，0.10 - 0.52；HR为0.86，95%置信区间，0.34 - 2.13）。mUIPI不良、中等和良好组的中位PFS分别为1.97个月（95%置信区间，1.15至未达到）、3.48个月（95%置信区间，1.58至未达到）和14.52个月（95%置信区间，5.75至未达到）（p < 0.001）。mUIPI不良、中等和良好组的中位OS分别为12.82、18.11和34.87个月（p = 0.28）。与中等和不良mUIPI相比，良好的mUIPI与更高的DCR相关（比值比[OR]分别为7.58，95%置信区间，1.73 - 43.69；OR为6.49，95%置信区间，0.14 - 295.42）。在亚组分析中，在男性患者以及患有下尿路原发肿瘤、肝转移、非一线治疗和单药治疗的患者亚组中，良好的mUIPI与改善的PFS相关。
结论：mUIPI可预测接受基于抗PD -1/PD -L1治疗的mUC患者的早期反应。
Introduction: The use of antibodies against programmed death receptor-1 (PD-1) and its ligand (PD-L1) has improved survival in metastatic urothelial carcinoma (mUC) patients. However, reliable and convenient biomarkers of early responses and outcomes are still lacking. Materials and Methods: We retrospectively screened mUC patients who received anti–PD-1/PD-L1–based therapy at our institute. A modified urothelium immune prognostic index (mUIPI) based on the neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) was developed to characterize the three groups as good, intermediate, and poor mUIPI. Major observations were progression-free survival (PFS), overall survival (OS), and disease control rate (DCR). Results: We identified 52 mUC patients with a median follow-up time of 29.8 months (95% CI, 26.3–53.2). Low NLR was with improved PFS and OS (hazard ratio [HR], 0.40, 95% CI, 0.18–0.92; HR, 0.27, 95% CI, 0.11–0.69, respectively). Normal LDH was associated with improved PFS but not OS (HR, 0.22, 95% CI, 0.10–0.52; HR, 0.86, 95% CI, 0.34–2.13, respectively). The median PFS for the poor, intermediate, and good mUIPI groups was 1.97 months (95% CI, 1.15 to NR), 3.48 months (95% CI, 1.58 to NR), and 14.52 months (95% CI, 5.75 to NR), respectively (p < 0.001). The median OS for the poor, intermediate, and good mUIPI was 12.82, 18.11, and 34.87 months, respectively (p = 0.28). A good mUIPI was associated with a higher DCR compared to intermediate and poor mUIPI (odds ratio [OR] 7.58, 95% CI, 1.73–43.69; OR, 6.49, 95% CI, 0.14–295.42, respectively). In the subgroup analysis, a good mUIPI was associated with improved PFS in the subgroups of male patients and patients with low urinary tract primary tumors, liver metastases, non–first-line treatment, and monotherapy. Conclusions: mUIPI predicts early responses in mUC patients who received anti–PD-1/PD-L1–based therapy.