探讨晚期尿路上皮癌(aUC)患者在初次化疗后病情得到控制的初始4个周期内肿瘤大小变化与2个周期化疗后肿瘤缩小的相关性。
我们回顾性分析了128例接受一线化疗的aUC患者。我们在第四个周期结束时分析了51例疾病控制(疾病稳定或更好)的患者。其中,47例患者接受1至2个周期的额外化疗,而其余患者接受观察。对于接受额外化疗的患者,额外化疗(5-6周期)后肿瘤大小的变化定义为“无收缩”(肿瘤生长),“小收缩”(无肿瘤生长或肿瘤大小缩小≤10%),或“收缩”(肿瘤大小减少>10%)。然后,我们调查了最初4个周期内肿瘤大小变化率与额外化疗后肿瘤大小变化率之间的关系.
在接受额外化疗的患者中,肿瘤大小的变化被归类为21例患者(44.7%)没有缩小,18例患者轻微萎缩(38.3%),和萎缩8例(17%)。关于额外化疗后肿瘤缩小的预测因素,第3周期和第4周期之间的肿瘤大小变化率(受试者工作特征曲线下面积=0.642)与肿瘤缩小趋势(P=0.009)和额外化疗后有益肿瘤缩小的可能性(轻微缩小+缩小;P=0.02)相关.然而,在第1周期和第2周期,第1周期和第4周期或第3周期和第4周期之间,肿瘤大小的变化不能令人满意地预测肿瘤的进一步缩小,因为肿瘤大小的变化有明显的重叠.
在成功诱导4周期化疗后,只有一小部分患者通过额外的周期会有实质性的肿瘤缩小。在最初的4个化疗周期中,肿瘤大小动力学显示出预测额外化疗后肿瘤进一步缩小的患者亚组的能力有限。因此,对于在第4个周期一线化疗后经历疾病控制的患者,最好考虑转换维持免疫治疗.
To investigate the correlation between tumor size changes during the initial 4 cycles of first-line chemotherapy and tumor shrinkage following 2 additional cycles of chemotherapy in patients with advanced urothelial carcinoma (aUC) who experienced disease control after initial chemotherapy.
We retrospectively reviewed 128 patients with aUC who received first-line chemotherapy. We analyzed 51 patients with disease control (stable disease or better) at the end of the fourth cycle. Of these, 47 patients received 1 to 2 additional cycles of chemotherapy, whereas the remaining patients underwent observation. For patients who received additional chemotherapy, the change in tumor size after additional chemotherapy (cycles 5-6) was defined as \"no shrinkage\" (tumor growth), \"minor shrinkage\" (no tumor growth or ≤10% reduction in tumor size), or \"shrinkage\" (>10% reduction in tumor size). Then, we investigated the relationship between the rate of tumor size change during the initial 4 cycles and that after additional chemotherapy.
Of the patients who received additional chemotherapy, the change in tumor size was categorized as no shrinkage in 21 patients (44.7%), minor shrinkage in 18 patients (38.3%), and shrinkage in 8 patients (17%). Regarding predictors of tumor shrinkage after additional chemotherapy, the rate of tumor size change between the cycles 3 and 4 (area under the receiver operating characteristics curve = 0.642) was correlated with the trend of the tumor shrinkage (P = 0.009) and the likelihood of beneficial tumor shrinkage after additional chemotherapy (minor shrinkage + shrinkage; P = 0.02). However, the change in tumor size between cycles 1 and 2, cycles 1 and 4, or cycles 3 and 4 was not satisfactorily predictive of further tumor shrinkage because of substantial overlaps of the tumor size changes.
Only a small subset of patients would have substantial tumor shrinkage by additional cycles after successful induction of 4 cycle chemotherapy. Tumor size dynamics during the initial 4 cycles of chemotherapy displayed limited ability to predict the subset of patients with further tumor shrinkage after additional chemotherapy. Therefore, it might be better to consider switch maintenance immunotherapy for patients who experience disease control after the fourth cycle of first-line chemotherapy.