The prognostic significance of histologic variant on survival outcomes in patients with metastatic urothelial carcinoma receiving immune checkpoint inhibitor therapy
Tsung-Han Tsai,
Po-Jung Su,
Shih-Yu Huang,
Ming-Chun Kuo,
Chang-Ting Lin,
Chia-Che Wu,
Hao-Lun Luo,
Chien-Hsu Chen,
Chih-Chi Chou,
Ting-Ting Liu,
Chun-Chieh Huang,
Kai-Lung Tsai,
Yu-Li Su
Affiliations
Tsung-Han Tsai
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Po-Jung Su
Division of Hematology Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University
Shih-Yu Huang
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Ming-Chun Kuo
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Chang-Ting Lin
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Chia-Che Wu
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Hao-Lun Luo
Department of Urology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Chien-Hsu Chen
Department of Urology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Chih-Chi Chou
Department of Pathology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University
Ting-Ting Liu
Department of Pathology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University
Chun-Chieh Huang
Department of Radiation Oncology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Kai-Lung Tsai
Department of Colorectal Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Yu-Li Su
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University
Abstract Background While the treatment guidelines have been established for pure urothelial carcinoma (pUC), patients with variant type urothelial carcinoma (vUC) face limited effective treatment options. The effectiveness of immune checkpoint inhibitors (ICI) in patients with vUC remains uncertain and necessitates additional research. Method We conducted a retrospective, multicenter study to explore the effectiveness of ICI in patients with pUC or vUC in Taiwan. We evaluated the overall response rate (ORR) through univariate logistic regression analysis and examined the overall survival (OS) and progression-free survival (PFS) using Kaplan-Meier analysis. Additionally, we employed univariate and multivariate Cox proportional hazards models to analyze the data. Result A total of 142 patients (116 pUC, 26 vUC) were included in our final analysis. The ORR was marginally higher in patients with pUC compared to those with vUC (34.5% vs. 23.1%, p = 0.26). Among all patients, 12.9% with pUC achieved a complete response (CR) after ICI treatment, while no vUC cases achieved CR (p = 0.05). There were no significant differences in PFS (median 3.6 months vs. 4.1 months, p = 0.34) or OS (median 16.3 months vs. 11.0 months, p = 0.24) when comparing patients with pUC or vUC. In the subgroup analysis, patients with pUC who underwent first-line ICI treatment exhibited significantly improved OS compared to those with vUC (24.6 months vs. 9.1 months, p = 0.004). Conclusion The use of ICI as monotherapy is a feasible and effective treatment approach for patients with metastatic vUC.
