Abstract：
The management of advanced (locally advanced or metastatic) urothelial carcinoma has been revolutionized since pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial carcinoma treated with pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver) metastasis, laboratory markers such as the neutrophil-to-lymphocyte ratio, sarcopenia, histological/genomic markers such as programmed cell death ligand 1 immunohistochemistry and tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary tumor site (bladder cancer versus upper tract urothelial carcinoma) and history/combination of radiotherapy. The survival time of advanced urothelial carcinoma has been significantly prolonged (or \'doubled\' from 1 to 2 years) after the advent of pembrolizumab, which will be further improved with novel agents such as avelumab and enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the contemporary era of immune checkpoint inhibitors.
摘要：
自2017年引入pembrolizumab以来，晚期（局部晚期或转移性）尿路上皮癌的管理已经发生了革命性的变化。已经报道了pembrolizumab治疗晚期尿路上皮癌的几种预后因素，包括常规参数，如性能状态和内脏（尤其是肝脏）转移，实验室标志物，如中性粒细胞与淋巴细胞的比率，少肌症,组织学/基因组标记，如程序性细胞死亡配体1免疫组织化学和肿瘤突变负荷，变异组织学,免疫相关不良事件，与肠道微生物组相关的伴随药物，原发性肿瘤部位（膀胱癌与上尿路尿路上皮癌）和病史/放疗组合。pembrolizumab出现后，晚期尿路上皮癌的生存时间显着延长（或从1年到2年增加了一倍），这将进一步改善与新的药物，如avelumab和enfortumabvedotin。这篇综述总结了在免疫检查点抑制剂当代晚期尿路上皮癌的临床结果和预后因素的最新证据。
