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

Chisato Narita; Fumihiko Urabe; Wataru Fukuokaya; Kosuke Iwatani; Yu Imai; Keiji Yasue; Keiichiro Mori; Koichi Aikawa; Takafumi Yanagisawa; Shoji Kimura; Kojiro Tashiro; Shunsuke Tsuzuki; Yuta Yamada; Steffi Kar Kei Yuen; Jeremy Yuen-Chun Teoh; Tatsuya Shimomura; Hiroki Yamada; Akira Furuta; Jun Miki; Takahiro Kimura; JIKEI-YAYOI Collaborative Group

doi:10.1016/j.clgc.2024.102082

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

Clin Genitourin Cancer. 2024 Mar 21:102082. doi: 10.1016/j.clgc.2024.102082. Online ahead of print.

Authors

Chisato Narita¹, Fumihiko Urabe², Wataru Fukuokaya¹, Kosuke Iwatani³, Yu Imai¹, Keiji Yasue¹, Keiichiro Mori¹, Koichi Aikawa¹, Takafumi Yanagisawa¹, Shoji Kimura³, Kojiro Tashiro⁴, Shunsuke Tsuzuki¹, Yuta Yamada⁵, Steffi Kar Kei Yuen⁶, Jeremy Yuen-Chun Teoh⁶, Tatsuya Shimomura¹, Hiroki Yamada⁴, Akira Furuta¹, Jun Miki³, Takahiro Kimura¹; JIKEI-YAYOI Collaborative Group

Affiliations

¹ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
² Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: furabe0809@gmail.com.
³ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan.
⁴ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan.
⁵ Department of Urology, University of Tokyo, Tokyo, Japan.
⁶ S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.

PMID: 38641443
DOI: 10.1016/j.clgc.2024.102082

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Adjuvant immunotherapy candidate; CheckMate 274 trial; Lymphovascular invasion; Upper tract urothelial carcinoma; Urothelial carcinoma.