Background: Despite the revolutionary impact of immune checkpoint inhibitors (ICIs) on the treatment of metastatic urothelial carcinoma (mUC), the clinical utility of reliable prognostic biomarkers to foresee survival outcomes remains underexplored.
Objectives: The purpose of this study was to ascertain the prognostic significance of serum inflammatory markers in mUC patients undergoing ICI therapy.
Design: This is a retrospective, multicenter study.
Methods: Data were collected from two independent medical centers in Taiwan, encompassing a validation and a training cohort (TC). Patients with histopathologically confirmed urothelial carcinoma who received at least one cycle of ICI monotherapy were included. Serum inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated prior to ICI therapy. Statistical analyses involved the use of receiver operating characteristic (ROC) curves to determine optimal biomarker cutoffs and Cox proportional hazards models to evaluate the independent predictive capability of these markers.
Results: A total of 192 patients were enrolled. In the univariate analysis, serum markers such as NLR, PLR, SII, and Hb were significantly associated with overall survival (OS) in both the training and validation cohorts (VC). White blood cells, NLR, and SII demonstrated a robust correlation with progression-free survival across both cohorts. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status ⩾2 (p < 0.001), visceral metastasis (p < 0.001), leukocytosis (p < 0.001), Hb levels ⩾10 mg/dL (p = 0.008), and NLR ⩾5 (p = 0.032) as independent predictors of OS. A prognostic nomogram integrating these independent factors yielded a C-index for a 3-year OS of 0.769 in the TC and 0.657 in the VC.
Conclusion: Serum inflammatory markers, combined with clinicopathologic factors, provide a practical prognostic tool in mUC treatment with ICIs.
Keywords: immune checkpoint inhibitor; leukocytosis; metastatic urothelial carcinoma; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; systemic immune-inflammation index.
Using blood tests and health information to predict survival in bladder cancer patients receiving immune therapy Study overview Despite the success of new immune therapies in treating advanced bladder cancer, we still need better ways to predict how well patients will respond to treatment. Our study looked at certain blood tests that measure inflammation to see if they can help predict patient outcomes. What we did We reviewed the medical records of 192 patients with advanced bladder cancer who were treated at two medical centers in Taiwan. These patients had received immune therapy, and we analyzed their blood for signs of inflammation before they started treatment. We specifically looked at the ratios of different types of blood cells involved in inflammation and immune response. What we found Certain blood markers were linked to how long patients lived after treatment. For example, patients with higher levels of certain inflammatory markers tended to have shorter survival times. We used this information along with other medical data to create a tool that helps predict how patients might do with treatment. What it means Our findings suggest that checking for inflammation in the blood could help doctors better understand who will benefit most from immune therapy for advanced bladder cancer. This could help tailor treatments more effectively for each patient.
© The Author(s), 2024.