Prognostic significance of pre-treatment albumin-bilirubin grade in metastatic urothelial carcinoma receiving pembrolizumab

Shimpei Yamashita; Takuma Wada; Ryusuke Deguchi; Nobuyuki Mashima; Masatoshi Higuchi; Haruka Miyai; Hiroyuki Koike; Yasuo Kohjimoto; Isao Hara

doi:10.1093/jjco/hyad069

Prognostic significance of pre-treatment albumin-bilirubin grade in metastatic urothelial carcinoma receiving pembrolizumab

Jpn J Clin Oncol. 2023 Aug 30;53(9):845-850. doi: 10.1093/jjco/hyad069.

Authors

Shimpei Yamashita¹, Takuma Wada¹, Ryusuke Deguchi¹, Nobuyuki Mashima², Masatoshi Higuchi³, Haruka Miyai⁴, Hiroyuki Koike⁵, Yasuo Kohjimoto¹, Isao Hara¹

Affiliations

¹ Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan.
² Department of Urology, Kinan Hospital, 46-70 Shinjyo, Tanabe, Wakayama 646-8588, Japan.
³ Department of Urology, Rinku General Medical Center, 2-23 Rinkuoraikita, Izumisano, Osaka 598-8577, Japan.
⁴ Department of Urology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori cho, Kishiwada, Osaka 596-0042, Japan.
⁵ Department of Urology, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama 640-8505, Japan.

PMID: 37357945
DOI: 10.1093/jjco/hyad069

Abstract

Background: Pre-treatment albumin-bilirubin grade is a useful biomarker for predicting prognosis in patients receiving immune checkpoint inhibitors for advanced malignancies. We evaluated the prognostic impact of pre-treatment albumin-bilirubin grade in patients receiving pembrolizumab for metastatic urothelial carcinoma.

Methods: In this multicenter retrospective study, we calculated pre-treatment albumin-bilirubin scores of 96 patients who received pembrolizumab for metastatic urothelial carcinoma between January 2018 and March 2022. Patients were classified according to albumin-bilirubin grade. Progression-free survival and cancer-specific survival were compared between the groups. To evaluate the prognostic impact of pre-treatment albumin-bilirubin grade, we also performed Cox proportional regression analyses for progression-free survival and cancer-specific survival.

Results: The median pre-treatment albumin bilirubin score was -2.52 (quartile: -2.76 to -2.10), and albumin-bilirubin grade was grade 1 in 37 patients (39%), grade 2a in 30 patients (31%), 2b in 22 patients (23%) and grade 3 in 7 patients (7%). The median progression-free survival and cancer-specific survival were 2 and 7 months, respectively. Progression-free survival and cancer-specific survival were significantly different between the albumin-bilirubin grade groups (P < 0.01 and P < 0.01, respectively) and prognosis became poorer as albumin-bilirubin grade increased. High albumin-bilirubin grade was shown in multivariable Cox proportional analyses to be independently associated with both poor progression-free survival and poor cancer-specific survival.

Conclusions: High pre-treatment albumin-bilirubin grade could be a significant independent predictor of poor prognosis in patients receiving pembrolizumab for advanced urothelial carcinoma.

Keywords: biomarkers; immune checkpoint inhibitors; prognosis; ureteral neoplasms; urinary bladder neoplasms.

Grants and funding

Clinical Study Support Center at Wakayama Medical University