Prognostic risk score and index including the platelet-to-lymphocyte ratio and lactate dehydrogenase in patients with metastatic or unresectable urothelial carcinoma treated with immune checkpoint inhibitors

Keita Kobayashi ¹, Shigeru Sakano ², Hiroaki Matsumoto ³

¹Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
²Department of Urology, Kokura Memorial Hospital, Kitakyushu, Japan.
³Department of Urology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
⁴Department of Urology and Nephrology, Tokuyama Central Hospital, Shunan, Japan.
⁵Department of Urology, Kanmon Medical Center, Shimonoseki, Japan.
⁶Department of Urology, Shuto General Hospital, Yanai, Japan.
⁷Department of Urology, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan.
⁸Department of Urology, Nagato General Hospital, Nagato, Japan.
⁹Department of Urology, Masuda Red Cross Hospital, Masuda, Japan.
¹⁰Department of Urology, Shimonoseki City Hospital, Shimonoseki, Japan.
¹¹Department of Urology, Sanyo-Onoda Municipal Hospital, Sanyo-Onoda, Japan.
¹²Department of Urology, Ube-kohsan Central Hospital Corp, Ube, Japan.
¹³Department of Urology, Shimonoseki Saiseikai Toyoura Hospital, Shimonoseki, Japan.
¹⁴Department of Urology, Ogori Daiichi General Hospital, Yamaguchi, Japan.
¹⁵Department of Urology, Hikari Municipal Hikari General Hospital, Hikari, Japan.

⁰Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.

Japanese Journal of Clinical Oncology +

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October 7, 2024

View abstract on PubMed

Summary

A new risk score using platelet-to-lymphocyte ratio and lactate dehydrogenase can predict outcomes for metastatic urothelial carcinoma patients receiving immune checkpoint inhibitors. This aids in personalized treatment strategies for better overall survival prediction.

Area Of Science

Oncology
Immunotherapy
Biomarker Discovery

Background

Metastatic urothelial carcinoma (mUC) treatment often involves platinum-based chemotherapy followed by immune checkpoint inhibitors (ICIs) like avelumab and pembrolizumab.
Predicting patient outcomes at the initiation of ICI therapy is crucial for treatment individualization.

Purpose Of The Study

To identify prognostic factors and develop a risk score for predicting outcomes in patients with metastatic or unresectable urothelial carcinoma receiving ICIs.
To evaluate the performance of a novel risk score against existing models.

Main Methods

Retrospective analysis of 243 patients with mUC treated with avelumab or pembrolizumab post-chemotherapy (Jan 2017-Dec 2022).
Examination of patient characteristics, tumor factors, and blood data (e.g., platelet-to-lymphocyte ratio, lactate dehydrogenase) at ICI initiation.
Development and validation of a new risk score, compared with Bellmunt and Lung Immune Prognostic Index scores.

Main Results

Eastern Cooperative Oncology Group performance status, visceral metastases, platelet-to-lymphocyte ratio, and lactate dehydrogenase were independent prognostic factors for overall survival.
The novel risk score demonstrated a high C-index (0.718) for overall survival prediction, outperforming existing scores.
Median overall survival varied significantly based on the risk score, from 58.5 months (score 0) to 3.9 months (score ≥3).

Conclusions

A risk score incorporating platelet-to-lymphocyte ratio and lactate dehydrogenase is a valuable tool for predicting prognosis in mUC patients starting ICI therapy.
This model can assist clinicians in stratifying patients and potentially guiding treatment decisions.

Keywords:

Bellmunt score immune checkpoint inhibitor lactate dehydrogenase platelet to lymphocyte ratio urothelial carcinoma