Site-Specific Differences of Eligibility for Adjuvant Immunotherapy Among Urothelial Carcinoma Patients Treated With Radical Surgery: Results From a Multicenter Cohort Study

• Published in: Clinical genitourinary cancer 2024-06, Vol.22 (3), p.102082-102082, Article 102082
• Main Authors: Narita, Chisato, Urabe, Fumihiko, Fukuokaya, Wataru, Iwatani, Kosuke, Imai, Yu, Yasue, Keiji, Mori, Keiichiro, Aikawa, Koichi, Yanagisawa, Takafumi, Kimura, Shoji, Tashiro, Kojiro, Tsuzuki, Shunsuke, Yamada, Yuta, Yuen, Steffi Kar Kei, Teoh, Jeremy Yuen-Chun, Shimomura, Tatsuya, Yamada, Hiroki, Furuta, Akira, Miki, Jun, Kimura, Takahiro
• Format: Article
• Language: English
• Subjects: Adjuvant immunotherapy candidate; CheckMate 274 trial; Lymphovascular invasion; Upper tract urothelial carcinoma; Urothelial carcinoma
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2024.102082

The CheckMate274 trial has reported enhanced disease-free survival rates in patients with stage pT3–4/ypT2–4 or pN+ urothelial carcinoma (UC) undergoing adjuvant nivolumab therapy. This study compares prognostic differences between urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC). We retrospectively analyzed data from 719 patients with UC who underwent radical surgery, stratifying to patients at stage pT3–4 and/or pN+ without neoadjuvant chemotherapy (NAC) or at ypT2–4 and/or ypN+ with NAC (potential candidates for adjuvant immunotherapy), and to those who were not candidates for adjuvant immunotherapy. We used Kaplan–Meier curves to assess oncological outcomes, particularly nonurothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Risk factors were identified by Cox regression analysis. Kaplan–Meier curves showed significantly lower NUTRFS, CSS, and OS for potential adjuvant immunotherapy candidates than for noncandidates in each UCB and UTUC group. NUTRFS, CSS, and OS did not differ significantly between adjuvant immunotherapy candidates with UBC or UTUC. Trends were similar among patients ineligible for adjuvant immunotherapy. Pathological T stage (pT3–4 or ypT2–4), pathological N stage, and lymphovascular invasion (LVI) were independent predictors of oncological outcomes on multivariate analysis. The criteria for adjuvant immunotherapy candidates from the CheckMate 274 trial can also effectively stratify UC patients after radical surgery. Substantial clinical significance is attached to LVI status as well as to pathological T and N status, suggesting that LVI status should be considered when selecting suitable candidates for adjuvant immunotherapy. A study of 719 urothelial carcinoma patients found lower survival rates in those eligible for adjuvant immunotherapy post-surgery, regardless of cancer type (bladder or upper tract). Key outcome predictors included pathological T and N stages, and lymphovascular invasion, supporting the use of CheckMate 274 criteria for therapy stratification and emphasizing the importance of vascular invasion.