放疗与一线化疗和免疫疗法联合治疗局部晚期/转移性尿路上皮癌症的有效性和安全性：倾向评分匹配分析
Efficacy and safety of combining radiotherapy with first-line chemotherapy and immunotherapy for local advanced/metastatic urothelial cancer: a propensity score matching analysis.
摘要(中文译文)
本研究评估放疗联合一线化疗及免疫检查点抑制剂治疗局部晚期或转移性尿路上皮癌（la/mUC）患者的有效性与安全性。本回顾性研究纳入2017年1月至2024年12月期间接受一线系统治疗的la/mUC患者。比较两种治疗策略：免疫治疗联合化疗后序贯放疗（ICRT组，n=31）与单纯免疫治疗联合化疗（ICT组，n=73）。采用倾向性评分匹配以减少混杂因素和选择偏倚，最终获得30对匹配患者。临床终点包括客观缓解率（ORR）、缓解持续时间（DOR）、无进展生存期（PFS）、总生存期（OS）及治疗相关不良事件。倾向性评分匹配后，ICRT组较ICT组显示PFS显著延长（18.70个月 vs. 7.93个月；=0.002）及OS显著延长（38.9个月 vs. 19.8个月；=0.031）。ICRT队列在所有评估时间点的PFS、OS及ORR均更高，其中6个月PFS、12个月PFS及12个月OS差异具有统计学意义（<0.05）。尽管ICRT组中位DOR在数值上更长（29.23个月 vs. 13.53个月），但差异未达统计学显著性（=0.385）。ICRT组观察到放射性肠炎和膀胱炎，未发生治疗相关死亡。多因素Cox回归分析确定肺转移、C反应蛋白水平升高、放疗及治疗反应超过疾病稳定为PFS的独立预测因素。肝转移、放疗及更好的治疗反应与OS独立相关。在la/mUC患者中，一线免疫治疗联合化疗基础上加用放疗显示出良好的临床活性和可接受的安全性。
Abstract
This study evaluates the effectiveness and safety of combining radiotherapy with first-line chemotherapy and immune checkpoint inhibitors in patients with locally advanced or metastatic urothelial carcinoma (la/mUC). This retrospective study included patients with la/mUC who received first-line systemic treatment between January 2017 and December 2024. Two treatment strategies were compared: immunotherapy combined with chemotherapy followed by radiotherapy (ICRT group, n = 31) and immunotherapy combined with chemotherapy alone (ICT group, n = 73). Propensity score matching was used to reduce confounding and selection bias, yielding 30 matched patient pairs. Clinical endpoints included objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events. After propensity score matching, the ICRT group showed significantly prolonged PFS (18.70 vs. 7.93 months; = 0.002) and OS (38.9 vs. 19.8 months; = 0.031) compared with the ICT group. The ICRT cohort demonstrated higher PFS, OS, and ORR across all evaluated time points, with statistically significant differences at 6-month PFS, 12-month PFS, and 12-month OS ( < 0.05). Although the median DOR was numerically longer in the ICRT group (29.23 vs. 13.53 months), the difference did not reach statistical significance ( = 0.385). Radiation-related enteritis and cystitis were observed in the ICRT group, while no treatment-related deaths occurred. Multivariate Cox regression analysis identified lung metastases, elevated C-reactive protein levels, radiotherapy, and treatment response exceeding stable disease as independent predictors of PFS. Liver metastases, radiotherapy, and better treatment response were independently associated with OS. The addition of radiotherapy to first-line immunotherapy and chemotherapy demonstrated favorable clinical activity and an acceptable safety profile in patients with la/mUC.
如何引用
AMA
Jian Qin, Hanjing Zhou, Xia Li, Hubin Yin, Hongbin Deng, Yi Luo, et al. Efficacy and safety of combining radiotherapy with first-line chemotherapy and immunotherapy for local advanced/metastatic urothelial cancer: a propensity score matching analysis.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1786952.
APA
Jian Qin, Hanjing Zhou, Xia Li, Hubin Yin, Hongbin Deng, Yi Luo, et al (2026). Efficacy and safety of combining radiotherapy with first-line chemotherapy and immunotherapy for local advanced/metastatic urothelial cancer: a propensity score matching analysis.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1786952
GB/T 7714
Jian Qin, Hanjing Zhou, Xia Li, Hubin Yin, Hongbin Deng, Yi Luo, et al. Efficacy and safety of combining radiotherapy with first-line chemotherapy and immunotherapy for local advanced/metastatic urothelial cancer: a propensity score matching analysis.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1786952.
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