Perioperative immunogenomics and clinical outcomes under ERAS-based nursing care in muscle-invasive bladder cancer
Lu-Lu Xin1, Jin-Jin Guo1, Xin-Ying Zheng1
1Department of Urology / Nursing Department, Cangzhou Central Hospital of Hebei Province, Cangzhou, Hebei, China.
Background:
Surgical trauma is associated with perioperative immune perturbation in muscle-invasive bladder cancer (MIBC). Enhanced Recovery After Surgery (ERAS) combines multidisciplinary perioperative management with structured nursing care, but its immunogenomic associations remain incompletely characterized.
Methods:
This retrospective historical-control cohort included 126 MIBC patients undergoing radical cystectomy with Bricker ileal conduit (ERAS-based care, n = 63; conventional care, n = 63). Serial peripheral immune profiling was performed at T0 (preoperative), T1 (24 h postoperative), and T2 (POD7/discharge). Tumor analyses included multiplex immunofluorescence, tumor mutational burden (TMB), and NanoString immune-gene profiling; spatial transcriptomics was performed in 24 specimens (12/group). Clinical outcomes included 30-day infectious complications and survival, while biomarker and immunogenomic analyses were considered exploratory.
Results:
ERAS-based care was associated with a less pronounced postoperative CD8+ T-cell decline (22.8% vs. 41.6%, P < 0.001) and lower T1 serum IL-6 (43.2 vs. 87.4 pg/mL, P < 0.001). An exploratory four-marker T1 immune index (CD8+ count, IL-6, sPD-L1, and NK activity) showed predictive performance for 30-day infectious complications (AUC = 0.84, 95% CI 0.76-0.92). In resection specimens, the ERAS cohort had a higher proportion of the immune-inflamed tumor immune microenvironment (TIME) phenotype (52.4% vs. 28.6%, P = 0.012). Exploratory survival analyses also identified associations with an eight-gene immune signature and TMB status; these findings require validation.
Conclusion:
In this retrospective cohort, ERAS-based perioperative nursing and multidisciplinary care were associated with differences in systemic immune recovery, postoperative outcomes, and cross-sectional tumor immune features. The proposed immune-marker and gene-signature findings are exploratory and require independent validation before clinical implementation.
