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Lookup NU author(s): Dr Pasquale RescignoORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© 2022 THE AUTHORS. BACKGROUND: The current prognostic models for patients with advanced urinary tract cancers were developed and validated in the chemotherapy setting. As immunotherapy has become the backbone of novel treatments, updated prognostic scores are needed. METHODS: A comprehensive analysis of inflammatory indexes from peripheral blood and clinical factors was planned on the entire real-world cohort of pretreated patients with advanced urinary tract carcinoma receiving atezolizumab in the prospective, single-arm, phase IIIb SAUL study. Univariable and multivariable analyses with overall survival as the primary endpoint, bootstrap internal validation, Schneeweiss scoring system and calibration test were performed to develop a novel immunotherapy prognostic score. RESULTS: Thirteen clinical variables from 1001 patients were analyzed. The following eight prognostic factors were included in a model: ECOG PS, liver and bone metastases, histology, pre-treatment steroids, systemic immune-inflammatory index (i.e., neutrophils-to-lymphocytes ratio times platelets count), hemoglobin and lactate dehydrogenase. The prognostic model was able to stratify patients into five risk groups with significantly different (P<0.001) median overall survival of NR, 18.0, 8.7, 4.6 and 2.4 months, respectively. The c-index for OS was higher than the Bellmunt Score one (0.702 vs. 0.672). CONCLUSIONS: A novel 5-class prognostic model contemporary to immunotherapy provides robust prognostic discrimination of patients with advanced urinary tract carcinoma homogeneously treated with immunotherapy through baseline affordable and reproducible clinical and laboratory factors. It could be quickly adopted in clinical practice to inform patients about prognosis with immunotherapy and assess the benefit of novel immunotherapy combinations in clinical trials.
Author(s): Fornarini G, Rebuzzi SE, Buti S, Rescigno P, Merseburger A, Sternberg CN, de Giorgi U, Basso U, Maruzzo M, Giannatempo P, Ponzano M, Giunta EF, Catalano F, Murianni V, Damassi A, Cremante M, Gandini A, Puglisi S, Llaja Obispo MA, Signori A, Banna GL
Publication type: Article
Publication status: Published
Journal: Minerva Urology and Nephrology
Year: 2023
Volume: 75
Issue: 3
Pages: 308-318
Print publication date: 01/06/2023
Online publication date: 13/12/2022
Acceptance date: 27/10/2022
Date deposited: 07/11/2024
ISSN (print): 2724-6051
ISSN (electronic): 2724-6442
Publisher: Edizioni Minerva Medica
URL: https://doi.org/10.23736/S2724-6051.22.05135-7
DOI: 10.23736/S2724-6051.22.05135-7
PubMed id: 36511379
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