A New Prognostic Model in Patients with Advanced Urothelial Carcinoma Treated with First-line Immune Checkpoint Inhibitors

Khaki, Ali Raza; Li, Ang; Diamantopoulos, Leonidas; Miller, Natalie J.; Carril-Ajuria, Lucía; Castellano, Daniel; Kouchkovsky, Ivan de; Koshkin, Vadim S.; Park, Joseph J.; Alva, Ajjai; Bilen, Mehmet Asım; Stewart, Tyler F.; Santos, Víctor Sacristán; Agarwal, Neeraj; Jain, Jayanshu; Zakharia, Yousef; Morales-Bárrera, Rafael; Devitt, Michael; Nelson, Ariel Ann; Hoimes, Christopher J.; Shreck, Evan; Gartrell, Benjamin A.; Sankin, Alex; Tripathi, Abhishek; Zakopoulou, Roubini; Bamias, Aristotelis; Rodríguez‐Vida, Alejo; Drakaki, Alexandra; Liu, Sandy; Kumar, Varun; Lythgoe, Mark P.; Pinato, David J.; Murgić, Jure; Fröbe, Ana; Joshi, Monika; Velho, Pedro Isaacsson; Hahn, Noah M.; Buznego, Lucía Alonso; Durán, Ignacio; Moses, Marcus W.; Barata, Pedro C.; Galsky, Matthew D.; Sonpavde, Guru; Yu, Evan Y.; Shankaran, Veena; Lyman, Gary H.; Grivas, Petros

doi:10.1016/j.euo.2020.12.006

Cited by 41 publications

(39 citation statements)

References 32 publications

(45 reference statements)

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“…Various prognostic factors of patients with mUC have been reported. They were mainly blood test results related to systemic inflammation 8 – 11 . Additionally, clinical items reflecting cancer-related cachexia have been mainly reported.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, clinical items reflecting cancer-related cachexia have been mainly reported. Further, the presence of liver metastasis has been reported as a poor prognostic factor for patients with mUC treated with either chemotherapy 19 or immunotherapy 8 – 12 . Although these previous studies used the same blood test results, the cut-off values of each item were different according to each cohort and their versatility was low.…”

Section: Discussionmentioning

confidence: 99%

“…The NLR has been often reported as a prognostic factor for various types of cancer, but its cut-off value has not been established. For UC, cut-off values of 3.0 10 , 11 and 5.0 8 have been reported, but in our study, we used 5.0 because this value was used in a previous study with a large number of cases.…”

Section: Discussionmentioning

confidence: 99%

“…The neutrophil–lymphocyte ratio (NLR) was calculated using the formula: neutrophil count/ lymphocyte count. The following cut-off values were defined according to previous reports: Fib-4 > 3.5 17 , ALBI score > − 2.6 16 , and NLR > 5.0 8 .…”

Section: Methodsmentioning

confidence: 99%

“…Several prognostic models have been reported for ICI therapy for metastatic UC (mUC) including the neutrophil-to-lymphocyte ratio (NLR) 8 – 11 , anaemia 10 , metastatic sites 8 – 12 , and/or performance status 8 – 12 . However, no prognostic models that use only blood test results have been created.…”

Section: Introductionmentioning

confidence: 99%

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FAN score comprising fibrosis-4 index, albumin–bilirubin score and neutrophil–lymphocyte ratio is a prognostic marker of urothelial carcinoma patients treated with pembrolizumab

Kawashima

Yamamoto

Sato

et al. 2021

Sci Rep

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It is important to identify prognostic and predictive markers of metastatic urothelial carcinoma (mUC) treated with immunocheckpoint inhibitors. We sought to establish a prognostic marker for patients with mUC treated with pembrolizumab based on only blood test results. We included 165 patients with mUC in the discovery cohort and 103 with mUC who were treated with pembrolizumab in the validation cohort. Multivariate and Cox regression analyses were used to analyse the data. In the discovery cohort, the fibrosis-4 index (hazard ratio [HR]: 2.13, 95% confidence interval [CI] 1.20–3.76, p = 0.010), albumin–bilirubin score (HR 1.91, 95% CI 1.27–2.88, p = 0.002), and neutrophil–lymphocyte ratio (HR: 1.84, 95% CI 1.22–2.79, p = 0.004) were independent significant prognostic factors. We established a ‘FAN score’ that included these three aforementioned items, which were assigned one point each. We divided patients into the 0–1 point (n = 116) and 2–3 points (n = 49) groups. The FAN score was a significant prognostic marker for cancer-specific survival (CSS) (HR 1.48, 95% CI 1.19–1.83, p < 0.001) along with the Eastern Cooperative Oncology Group Performance Status. The FAN score was also a prognostic factor of progression-free survival (PFS) (HR: 1.25, 95% CI 1.01–1.54, p = 0.036) along with the presence of liver metastasis. In the validation cohort, the FAN score was a significant prognostic factor for CSS (HR: 1.48, 95% CI 1.19–1.85, p = 0.001) and PFS (HR: 1.29, 95% CI 1.02–1.62, p = 0.034). We established the FAN score as a prognostic marker for patients with mUC treated with pembrolizumab.

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Section: Discussionmentioning

confidence: 99%