BJU international · 2025
Immunotherapy-based neoadjuvant treatment and complication rates after radical cystectomy.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Ben-David Reuben, Pellegrino Francesco, Mehrazin Reza, Thomas Joel, Geduldig Jack, Lidagoster Sarah, Garden Evan B, Attalla Kyrollis, Eraky Ahmed, Zaurito Paolo, Moschini Marco, Briganti Alberto, Montorsi Francesco, Sfakianos John P, Wiklund Peter
Аннотация
OBJECTIVE: To assess 30- and 90-day postoperative complication rates in patients who underwent robot-assisted radical cystectomy (RARC) after receiving novel immunotherapy-based neoadjuvant treatment.
METHODS: A bi-centre analysis was conducted in patients who underwent RARC with intracorporeal urinary diversion and who received an immunotherapy-based neoadjuvant regimen between 2017 and 2023. Complications were classified using the Clavien-Dindo system.
RESULTS: The cohort included 136 patients, with a median (interquartile range [IQR]) age of 66 (61-73) years, of whom 22 were female (16.2%). The overall 30-day and 31-90-day Clavien-Dindo grade ≥3a complication rates were 15.4%, and 14.7%, respectively. The most common cumulative 90-day complications by category were infectious (59.6%), genitourinary (33.1%), and gastrointestinal (22.7%). The median (IQR) hospital stay was 11 (7-16) days, and 36 patients (26.5%) required readmission. Eighty-four patients received monotherapy with an immune checkpoint inhibitor and 52 received combination immunochemotherapy. A higher rate of 30-day infectious complications was seen in the immuno-monotherapy group (46.4% vs 26.9%; P = 0.03), while pulmonary complications were more commonly reported in the combination immunochemotherapy group (9.6% vs 1.2%; P = 0.03). No statistically significant differences were found in the other complication categories between the groups. Eleven patients (8.1%) experienced 13 (9.6%) immune-related adverse events (irAEs). The most common irAEs were hypothyroidism and dermatitis.
CONCLUSIONS: The cumulative 90-day complication rate after novel immunotherapy-based neoadjuvant treatment appears higher than those previously reported for RARC alone or for chemotherapy-based neoadjuvant regimens. We observed irAEs in 8.1% of patients after RARC, highlighting the need for urologists to recognise such events.
METHODS: A bi-centre analysis was conducted in patients who underwent RARC with intracorporeal urinary diversion and who received an immunotherapy-based neoadjuvant regimen between 2017 and 2023. Complications were classified using the Clavien-Dindo system.
RESULTS: The cohort included 136 patients, with a median (interquartile range [IQR]) age of 66 (61-73) years, of whom 22 were female (16.2%). The overall 30-day and 31-90-day Clavien-Dindo grade ≥3a complication rates were 15.4%, and 14.7%, respectively. The most common cumulative 90-day complications by category were infectious (59.6%), genitourinary (33.1%), and gastrointestinal (22.7%). The median (IQR) hospital stay was 11 (7-16) days, and 36 patients (26.5%) required readmission. Eighty-four patients received monotherapy with an immune checkpoint inhibitor and 52 received combination immunochemotherapy. A higher rate of 30-day infectious complications was seen in the immuno-monotherapy group (46.4% vs 26.9%; P = 0.03), while pulmonary complications were more commonly reported in the combination immunochemotherapy group (9.6% vs 1.2%; P = 0.03). No statistically significant differences were found in the other complication categories between the groups. Eleven patients (8.1%) experienced 13 (9.6%) immune-related adverse events (irAEs). The most common irAEs were hypothyroidism and dermatitis.
CONCLUSIONS: The cumulative 90-day complication rate after novel immunotherapy-based neoadjuvant treatment appears higher than those previously reported for RARC alone or for chemotherapy-based neoadjuvant regimens. We observed irAEs in 8.1% of patients after RARC, highlighting the need for urologists to recognise such events.