New risk stratification for adjuvant nivolumab for high-risk muscle-invasive urothelial carcinoma

Area of Science:

• Uro-oncology
• Medical oncology
• Surgical oncology

Background:

• Muscle-invasive urothelial carcinoma (MIUC) requires aggressive treatment.
• Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is a standard approach for MIUC.
• The role of adjuvant immunotherapy, such as nivolumab, in optimizing outcomes after NAC and RC is under investigation, particularly for specific pathological staging.

Purpose of the Study:

• To evaluate the risk of disease recurrence after neoadjuvant chemotherapy and radical cystectomy in patients with urothelial carcinoma.
• To specifically assess recurrence risk in patients with ypT2 disease.
• To inform treatment decisions regarding adjuvant nivolumab for high-risk MIUC.

Main Methods:

• Retrospective analysis of 197 patients who underwent NAC and RC without adjuvant chemotherapy.
• Assessment of radiological and clinicopathological features, including clinical T (cT) and post-neoadjuvant pathological T (ypT) stages.
• Stratification of postoperative recurrence risk based on identified factors.

Main Results:

• ypT stage and lymphovascular invasion were independent risk factors for postoperative recurrence.
• Patients with ypT2 disease had significantly better recurrence-free survival (RFS) than those with ypT3 disease.
• In ypT2 disease, patients with cT2/ypT2 stage had significantly better RFS than those with cT3/4 and ypT2 stage.

Conclusions:

• Patients with cT2 and ypT2 pathological stage after NAC and RC exhibit a relatively low risk of recurrence.
• The findings suggest a potentially lower need for adjuvant nivolumab in this specific subgroup.
• Further research may refine adjuvant treatment strategies based on detailed pathological assessment post-NAC.