在VESPER试验中整体生存的预后因素:基底分子亚型是一个相关的关键因素
Christian Pfister1, Valentin Harter2, Jacqueline Fontugne3
1Department of Urology, Charles Nicolle University Hospital, Rouen, France; Onco-Urology Inserm Group 1404, Clinical Investigation Center, Rouen, France.
包括基底分子亚型在内的四个因素预测了接受新辅助化疗和囊切除术的肌肉侵入性膀癌患者的整体存活率. 识别这些预后标记可以改善生存预测.
科学领域:
- 在瘤学瘤学.
- 尿癌研究 尿癌研究
- 临床试验分析
背景情况:
- 肌肉侵入性膀癌 (MIBC) 治疗通常涉及新辅助化疗 (NAC),随后是囊切除术.
- 确定总生存期 (OS) 的预后因素对于治疗分层至关重要.
- 在VESPER试验中,在MIBC患者中评估了不同的NAC疗法.
研究的目的:
- 在VESPER试验中,确定治疗NAC和囊切除术的MIBC患者整体生存 (OS) 的预后因素.
- 评估OS的临床,生物,病理和分子特征的预测价值.
- 为了确定这个患者队列中OS最重要的预后因素.
主要方法:
- 对NAC VESPER试验群体 (n=437) 的分析,比较剂量密集的MVAC与凝胺/柏.
- 瘤幻灯片和块的中央审查来自297个尿路细胞癌病例.
- 通过单变量和多变量分析,研究临床,病理和分子特征及其对OS的影响.
主要成果:
- 统一分析显示,肌素清除,淋巴血管侵袭,围神经侵袭和分子亚型是OS的显著预后因素.
- 基底/状分子亚型显示出高预后价值,特别是在随机化后的前1-5年内.
- 多变量分析证实了这四个因素对OS预测是互补的;与没有 (72%) 或一个因素 (67%) 相比,具有两种或更多因素的患者5年后的OS率 (38%) 显着较低.
结论:
- 在VESPER试验中,在接受NAC治疗的MIBC患者中确定了OS的四个关键预后因素.
- 基底分子亚型成为最重要的预后因素,独立于治疗组.
- 这些发现强调了这些因素对于提高预后准确性和潜在指导MIBC治疗决策的重要性.
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