International journal of urology : official journal of the Japanese Urological Association · 2025
Impact of lymph node dissection during surgery on the efficacy of pembrolizumab in patients with metastatic urothelial carcinoma.
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Kanno Toru, Ito Katsuhiro, Kita Yuki, Mochizuki Takanori, Sano Tomoyasu, Yokomizo Akira, Abe Takashige, Tsuchihashi Kazunari, Tatarano Shuichi, Inokuchi Junichi, Takahashi Atsushi, Matsui Yoshiyuki, Nishiyama Hiroyuki, Kitamura Hiroshi, Saito Ryoichi, Kobayashi Takashi, Japan Urological Oncology Group
Аннотация
OBJECTIVES: The impact of lymph node dissection (LND) on the efficacy of pembrolizumab in patients with urothelial carcinoma (UC) who develop metastasis after surgery remains unclear. This study aimed to investigate the efficacy of pembrolizumab in patients with metastatic UC who underwent primary tumor resection with LND.
PATIENTS AND METHODS: This retrospective study included patients who initially underwent radical surgery with or without LND for non-metastatic UC and later received pembrolizumab for recurrent lesions. Data were collected from a retrospective nationwide Japanese cohort study in patients with metastatic UC treated with pembrolizumab. The primary endpoints were overall response rate (ORR) and overall survival (OS). Multivariate analysis was performed to identify predictors of OS.
RESULTS: A total of 393 patients (273 [69.5%] underwent LND, and 120 (30.5%) did not) were included in this study. The ORRs for patients with and without LND were 30.8% and 27.3%, respectively (p = 0.460). No significant difference in OS was observed between the two groups (p = 0.471). Multivariate Cox regression analysis revealed that a neutrophil-to-lymphocyte ratio ≥3.0, Eastern Cooperative Oncology Group performance status ≥2, hemoglobin <11, and liver metastasis were associated with worse OS. However, LND was not associated with OS.
CONCLUSIONS: LND during primary tumor resection did not affect the efficacy of pembrolizumab in patients with metastatic UC.
PATIENTS AND METHODS: This retrospective study included patients who initially underwent radical surgery with or without LND for non-metastatic UC and later received pembrolizumab for recurrent lesions. Data were collected from a retrospective nationwide Japanese cohort study in patients with metastatic UC treated with pembrolizumab. The primary endpoints were overall response rate (ORR) and overall survival (OS). Multivariate analysis was performed to identify predictors of OS.
RESULTS: A total of 393 patients (273 [69.5%] underwent LND, and 120 (30.5%) did not) were included in this study. The ORRs for patients with and without LND were 30.8% and 27.3%, respectively (p = 0.460). No significant difference in OS was observed between the two groups (p = 0.471). Multivariate Cox regression analysis revealed that a neutrophil-to-lymphocyte ratio ≥3.0, Eastern Cooperative Oncology Group performance status ≥2, hemoglobin <11, and liver metastasis were associated with worse OS. However, LND was not associated with OS.
CONCLUSIONS: LND during primary tumor resection did not affect the efficacy of pembrolizumab in patients with metastatic UC.
Предметные рубрики MeSH
HumansAntibodies, Monoclonal, HumanizedMaleFemaleRetrospective StudiesAgedMiddle AgedCarcinoma, Transitional CellLymph Node ExcisionLymphatic MetastasisTreatment OutcomeUrinary Bladder NeoplasmsAged, 80 and overAntineoplastic Agents, ImmunologicalJapanNeoplasm Recurrence, LocalSurvival RateCystectomy