Perioperative immunogenomics and clinical outcomes under ERAS-based nursing care in muscle-invasive bladder cancer.

IF 3 3区生物学 Q2 GENETICS & HEREDITY

Frontiers in Genetics Pub Date : 2026-10-14 eCollection Date: 2026-01-01 DOI:10.3389/fgene.2026.1967034

Lu-Lu Xin, Jin-Jin Guo, Xin-Ying Zheng, Zhao-Yang Li

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引用次数: 0

Abstract

Background: Surgical trauma is associated with perioperative immune perturbation in muscle-invasive bladder cancer (MIBC). Enhanced Recovery After Surgery (ERAS) combines multidisciplinary perioperative management with structured nursing care, but its immunogenomic associations remain incompletely characterized.

Methods: This retrospective historical-control cohort included 126 MIBC patients undergoing radical cystectomy with Bricker ileal conduit (ERAS-based care, n = 63; conventional care, n = 63). Serial peripheral immune profiling was performed at T0 (preoperative), T1 (24 h postoperative), and T2 (POD7/discharge). Tumor analyses included multiplex immunofluorescence, tumor mutational burden (TMB), and NanoString immune-gene profiling; spatial transcriptomics was performed in 24 specimens (12/group). Clinical outcomes included 30-day infectious complications and survival, while biomarker and immunogenomic analyses were considered exploratory.

Results: ERAS-based care was associated with a less pronounced postoperative CD8⁺ T-cell decline (22.8% vs. 41.6%, P < 0.001) and lower T1 serum IL-6 (43.2 vs. 87.4 pg/mL, P < 0.001). An exploratory four-marker T1 immune index (CD8⁺ count, IL-6, sPD-L1, and NK activity) showed predictive performance for 30-day infectious complications (AUC = 0.84, 95% CI 0.76-0.92). In resection specimens, the ERAS cohort had a higher proportion of the immune-inflamed tumor immune microenvironment (TIME) phenotype (52.4% vs. 28.6%, P = 0.012). Exploratory survival analyses also identified associations with an eight-gene immune signature and TMB status; these findings require validation.

Conclusion: In this retrospective cohort, ERAS-based perioperative nursing and multidisciplinary care were associated with differences in systemic immune recovery, postoperative outcomes, and cross-sectional tumor immune features. The proposed immune-marker and gene-signature findings are exploratory and require independent validation before clinical implementation.

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肌肉浸润性膀胱癌围手术期免疫基因组学及基于erass护理的临床结果。

背景：手术创伤与肌肉浸润性膀胱癌（MIBC）围手术期免疫紊乱有关。加强术后恢复（ERAS）结合了多学科围手术期管理和结构化护理，但其免疫基因组学相关性仍不完全明确。方法：该回顾性历史对照队列包括126例接受Bricker回肠导管根治性膀胱切除术的MIBC患者（基于erass的治疗，n = 63；常规治疗，n = 63）。在T0（术前）、T1（术后24小时）和T2 （POD7/出院）进行一系列外周免疫分析。肿瘤分析包括多重免疫荧光、肿瘤突变负荷（TMB）和纳米链免疫基因谱；对24个标本（每组12个）进行空间转录组学分析。临床结果包括30天感染并发症和生存，而生物标志物和免疫基因组学分析被认为是探索性的。结果：基于erass的护理与较不明显的术后CD8+ t细胞下降（22.8%对41.6%,P < 0.001）和较低的T1血清IL-6（43.2对87.4 pg/mL, P < 0.001）相关。探索性四标志物T1免疫指数（CD8+计数、IL-6、sPD-L1和NK活性）显示了对30天感染性并发症的预测性能（AUC = 0.84, 95% CI 0.76-0.92）。在切除标本中，ERAS队列具有更高比例的免疫炎症肿瘤免疫微环境（TIME）表型（52.4% vs. 28.6%, P = 0.012）。探索性生存分析还发现了与8个基因免疫特征和TMB状态的关联；这些发现需要验证。结论：在这个回顾性队列中，基于erass的围手术期护理和多学科护理与全身免疫恢复、术后结局和肿瘤横断面免疫特征的差异相关。提出的免疫标记和基因标记的发现是探索性的，在临床应用之前需要独立的验证。

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

Frontiers in Genetics Biochemistry, Genetics and Molecular Biology-Molecular Medicine

CiteScore

5.50

自引率

8.10%

发文量

3491

审稿时长

14 weeks

期刊介绍： Frontiers in Genetics publishes rigorously peer-reviewed research on genes and genomes relating to all the domains of life, from humans to plants to livestock and other model organisms. Led by an outstanding Editorial Board of the world’s leading experts, this multidisciplinary, open-access journal is at the forefront of communicating cutting-edge research to researchers, academics, clinicians, policy makers and the public. The study of inheritance and the impact of the genome on various biological processes is well documented. However, the majority of discoveries are still to come. A new era is seeing major developments in the function and variability of the genome, the use of genetic and genomic tools and the analysis of the genetic basis of various biological phenomena.