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タイトル: | Risk stratification for the prognosis of patients with chemoresistant urothelial cancer treated with pembrolizumab |
著者: | Kobayashi, Takashi Ito, Katsuhiro Kojima, Takahiro Kato, Minoru Kanda, Souhei Hatakeyama, Shingo Matsui, Yoshiyuki Matsushita, Yuto Naito, Sei Shiga, Masanobu Miyake, Makito Muro, Yusuke Nakanishi, Shotaro Kato, Yoichiro Shibuya, Tadamasa Hayashi, Tetsutaro Yasumoto, Hiroaki Yoshida, Takashi Uemura, Motohide Taoka, Rikiya Kamiyama, Manabu Ogawa, Osamu Kitamura, Hiroshi Nishiyama, Hiroyuki The Japan Urological Oncology Group |
著者名の別形: | 小林, 恭 小川, 修 |
キーワード: | metastatic urothelial cancer multivariate risk stratification model overall survival pembrolizumab prognostic variables |
発行日: | Feb-2021 |
出版者: | Wiley Japanese Cancer Association |
誌名: | Cancer Science |
巻: | 112 |
号: | 2 |
開始ページ: | 760 |
終了ページ: | 773 |
抄録: | The use of immune checkpoint inhibitors to treat urothelial carcinoma (UC) is increasing rapidly without clear guidance for validated risk stratification. This multicenter retrospective study collected clinicopathological information on 463 patients, and 11 predefined variables were analyzed to develop a multivariate model predicting overall survival (OS). The model was validated using an independent dataset of 292 patients. Patient characteristics and outcomes were well balanced between the discovery and validation cohorts, which had median OS times of 10.2 and 12.5 mo, respectively. The final validated multivariate model was defined by risk scores based on the hazard ratios (HRs) of independent prognostic factors including performance status, site of metastasis, hemoglobin levels, and the neutrophil-to-lymphocyte ratio. The median OS times (95% confidence intervals [CIs]) for the low-, intermediate-, and high-risk groups (discovery cohort) were not yet reached (NYR) (NYR–19.1), 6.8 mo (5.8-8.9), and 2.3 mo (1.2-2.6), respectively. The HRs (95% CI) for OS in the low- and intermediate-risk groups vs the high-risk group were 0.07 (0.04-0.11) and 0.23 (0.15-0.37), respectively. The objective response rates for in the low-, intermediate-, and high-risk groups were 48.3%, 28.8%, and 10.5%, respectively. These differential outcomes were well reproduced in the validation cohort and in patients who received pembrolizumab after perioperative or first-line chemotherapy (N = 584). In conclusion, the present study developed and validated a simple prognostic model predicting the oncological outcomes of pembrolizumab-treated patients with chemoresistant UC. The model provides useful information for external validation, patient counseling, and clinical trial design. |
著作権等: | © 2020 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
URI: | http://hdl.handle.net/2433/277835 |
DOI(出版社版): | 10.1111/cas.14762 |
PubMed ID: | 33283385 |
出現コレクション: | 学術雑誌掲載論文等 |
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