Impact of lymph node dissection during surgery on the efficacy of pembrolizumab in patients with metastatic urothelial carcinoma.

IF 1.8 3区医学 Q3 UROLOGY & NEPHROLOGY

International Journal of Urology Pub Date : 2025-02-10 DOI:10.1111/iju.70002

Toru Kanno, Katsuhiro Ito, Yuki Kita, Takanori Mochizuki, Tomoyasu Sano, Akira Yokomizo, Takashige Abe, Kazunari Tsuchihashi, Shuichi Tatarano, Junichi Inokuchi, Atsushi Takahashi, Yoshiyuki Matsui, Hiroyuki Nishiyama, Hiroshi Kitamura, Ryoichi Saito, Takashi Kobayashi

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引用次数: 0

Abstract

Objectives: The impact of lymph node dissection (LND) on the efficacy of pembrolizumab in patients with urothelial carcinoma (UC) who develop metastasis after surgery remains unclear. This study aimed to investigate the efficacy of pembrolizumab in patients with metastatic UC who underwent primary tumor resection with LND.

Patients and methods: This retrospective study included patients who initially underwent radical surgery with or without LND for non-metastatic UC and later received pembrolizumab for recurrent lesions. Data were collected from a retrospective nationwide Japanese cohort study in patients with metastatic UC treated with pembrolizumab. The primary endpoints were overall response rate (ORR) and overall survival (OS). Multivariate analysis was performed to identify predictors of OS.

Results: A total of 393 patients (273 [69.5%] underwent LND, and 120 (30.5%) did not) were included in this study. The ORRs for patients with and without LND were 30.8% and 27.3%, respectively (p = 0.460). No significant difference in OS was observed between the two groups (p = 0.471). Multivariate Cox regression analysis revealed that a neutrophil-to-lymphocyte ratio ≥3.0, Eastern Cooperative Oncology Group performance status ≥2, hemoglobin <11, and liver metastasis were associated with worse OS. However, LND was not associated with OS.

Conclusions: LND during primary tumor resection did not affect the efficacy of pembrolizumab in patients with metastatic UC.

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目的：对于术后发生转移的尿路上皮癌（UC）患者，淋巴结清扫（LND）对pembrolizumab疗效的影响仍不明确。本研究旨在探讨pembrolizumab对接受原发肿瘤切除术并伴有LND的转移性UC患者的疗效：这项回顾性研究纳入了最初因非转移性UC接受根治性手术（带或不带LND），之后因复发病灶接受pembrolizumab治疗的患者。数据收集自一项日本全国范围内的回顾性队列研究，研究对象为接受过pembrolizumab治疗的转移性UC患者。主要终点是总反应率（ORR）和总生存率（OS）。研究还进行了多变量分析，以确定OS的预测因素：本研究共纳入 393 例患者（273 例[69.5%]接受了 LND，120 例（30.5%）未接受 LND）。接受和未接受LND治疗的患者的ORR分别为30.8%和27.3%（P = 0.460）。两组患者的 OS 无明显差异（p = 0.471）。多变量考克斯回归分析显示，中性粒细胞与淋巴细胞比值≥3.0、东部合作肿瘤学组表现状态≥2、血红蛋白原发肿瘤切除术中的 LND 不会影响 pembrolizumab 对转移性 UC 患者的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Urology 医学-泌尿学与肾脏学

CiteScore

4.70

自引率

11.50%

发文量

340

审稿时长

3 months

期刊介绍： International Journal of Urology is the official English language journal of the Japanese Urological Association, publishing articles of scientific excellence in urology. Submissions of papers from all countries are considered for publication. All manuscripts are subject to peer review and are judged on the basis of their contribution of original data and ideas or interpretation.