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Abstract：
OBJECTIVE: The number of available treatment options for urothelial carcinoma has increased recently. Upper tract urothelial carcinoma (UTUC) is relatively rare compared with bladder cancer. There are few reports on the efficacy of immune checkpoint inhibitors (ICIs) for metastatic UTUC, and ICIs may occasionally show less efficacy and cause severe side effects. Therefore, it is important to predict the treatment response and change the treatment strategy as appropriate. We investigated the prognostic factors for treatment response in patients with metastatic UTUC treated with pembrolizumab at our hospital.
METHODS: Patients who received pembrolizumab for UTUC between January 2018 and June 2023 were analyzed. Patients who presented with bladder cancer complications at initial diagnosis were excluded. The primary endpoints assessed were overall survival (OS) and progression-free survival (PFS). Statistical analyses were conducted using laboratory values obtained before and after pembrolizumab administration. The relationship between cancer and inflammation is important. Therefore, we analyzed this relationship using prognostic factors for urothelial carcinoma as previously reported. Specifically, pretreatment C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and NLR/albumin values were examined.
RESULTS: Forty-seven patients were analyzed. The median PFS was 66 days (24-107 days), and the median OS was 164 days (13-314 days). A CRP level <1 before the first cycle was a useful factor in the multivariate analysis for both OS and PFS [OS: p=0.004, hazard ratio (HR)=3.244, 95% confidence interval (CI)=1.464-7.104; PFS: p=0.003, HR=2.998, 95%CI=1.444-6.225].
CONCLUSIONS: CRP level is a prognostic factor for pembrolizumab treatment response in patients with UTUC.
METHODS: Patients who received pembrolizumab for UTUC between January 2018 and June 2023 were analyzed. Patients who presented with bladder cancer complications at initial diagnosis were excluded. The primary endpoints assessed were overall survival (OS) and progression-free survival (PFS). Statistical analyses were conducted using laboratory values obtained before and after pembrolizumab administration. The relationship between cancer and inflammation is important. Therefore, we analyzed this relationship using prognostic factors for urothelial carcinoma as previously reported. Specifically, pretreatment C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and NLR/albumin values were examined.
RESULTS: Forty-seven patients were analyzed. The median PFS was 66 days (24-107 days), and the median OS was 164 days (13-314 days). A CRP level <1 before the first cycle was a useful factor in the multivariate analysis for both OS and PFS [OS: p=0.004, hazard ratio (HR)=3.244, 95% confidence interval (CI)=1.464-7.104; PFS: p=0.003, HR=2.998, 95%CI=1.444-6.225].
CONCLUSIONS: CRP level is a prognostic factor for pembrolizumab treatment response in patients with UTUC.
摘要：
目的：最近尿路上皮癌的可用治疗选择数量有所增加。与膀胱癌相比，上尿路尿路上皮癌（UTUC）相对罕见。关于免疫检查点抑制剂（ICIs）对转移性UTUC的疗效的报道很少，和ICIs可能偶尔显示疗效较低，并引起严重的副作用。因此,预测治疗反应并酌情改变治疗策略非常重要。我们调查了在我们医院接受派姆单抗治疗的转移性UTUC患者治疗反应的预后因素。
方法：对2018年1月至2023年6月接受派姆单抗治疗UTUC的患者进行分析。最初诊断时出现膀胱癌并发症的患者被排除在外。评估的主要终点是总生存期（OS）和无进展生存期（PFS）。使用在给予派姆单抗之前和之后获得的实验室值进行统计分析。癌症和炎症之间的关系很重要。因此,我们使用先前报道的尿路上皮癌的预后因素分析了这种关系.具体来说,治疗前C反应蛋白(CRP)水平,中性粒细胞与淋巴细胞比率（NLR），并检查NLR/白蛋白值。
结果：分析47例患者。中位PFS为66天（24-107天），中位OS为164天（13-314天）。在多变量分析中，第一个周期前CRP水平<1是OS和PFS的有用因素[OS：p=0.004，风险比（HR）=3.244，95％置信区间（CI）=1.464-7.104；PFS：p=0.003，HR=2.998，95CI=1.444-6.225]。
结论：CRP水平是UTUC患者派姆单抗治疗反应的预后因素。
方法：对2018年1月至2023年6月接受派姆单抗治疗UTUC的患者进行分析。最初诊断时出现膀胱癌并发症的患者被排除在外。评估的主要终点是总生存期（OS）和无进展生存期（PFS）。使用在给予派姆单抗之前和之后获得的实验室值进行统计分析。癌症和炎症之间的关系很重要。因此,我们使用先前报道的尿路上皮癌的预后因素分析了这种关系.具体来说,治疗前C反应蛋白(CRP)水平,中性粒细胞与淋巴细胞比率（NLR），并检查NLR/白蛋白值。
结果：分析47例患者。中位PFS为66天（24-107天），中位OS为164天（13-314天）。在多变量分析中，第一个周期前CRP水平<1是OS和PFS的有用因素[OS：p=0.004，风险比（HR）=3.244，95％置信区间（CI）=1.464-7.104；PFS：p=0.003，HR=2.998，95CI=1.444-6.225]。
结论：CRP水平是UTUC患者派姆单抗治疗反应的预后因素。
