The CheckMate274 trial has reported enhanced disease-free survival rates in patients with stage pT3–4/ypT2–4 or pN+ urothelial carcinoma (UC) undergoing adjuvant nivolumab therapy. This study compares prognostic differences between urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC). We retrospectively analyzed data from 719 patients with UC who underwent radical surgery, stratifying to patients at stage pT3–4 and/or pN+ without neoadjuvant chemotherapy (NAC) or at ypT2–4 and/or ypN+ with NAC (potential candidates for adjuvant immunotherapy), and to those who were not candidates for adjuvant immunotherapy. We used Kaplan–Meier curves to assess oncological outcomes, particularly nonurothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Risk factors were identified by Cox regression analysis. Kaplan–Meier curves showed significantly lower NUTRFS, CSS, and OS for potential adjuvant immunotherapy candidates than for noncandidates in each UCB and UTUC group. NUTRFS, CSS, and OS did not differ significantly between adjuvant immunotherapy candidates with UBC or UTUC. Trends were similar among patients ineligible for adjuvant immunotherapy. Pathological T stage (pT3–4 or ypT2–4), pathological N stage, and lymphovascular invasion (LVI) were independent predictors of oncological outcomes on multivariate analysis. The criteria for adjuvant immunotherapy candidates from the CheckMate 274 trial can also effectively stratify UC patients after radical surgery. Substantial clinical significance is attached to LVI status as well as to pathological T and N status, suggesting that LVI status should be considered when selecting suitable candidates for adjuvant immunotherapy.

中文翻译：

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接受根治性手术治疗的尿路上皮癌患者辅助免疫治疗资格的具体部位差异：多中心队列研究的结果

CheckMate274 试验报告称，接受纳武单抗辅助治疗的 pT3–4/ypT2–4 期或 pN+ 尿路上皮癌 (UC) 患者的无病生存率有所提高。本研究比较了膀胱尿路上皮癌（UCB）和上尿路尿路上皮癌（UTUC）之间的预后差异。我们回顾性分析了 719 名接受根治性手术的 UC 患者的数据，分层为 pT3–4 期和/或 pN+ 期且未接受新辅助化疗 (NAC) 的患者或 ypT2–4 期和/或 ypN+ 期接受 NAC 的患者（辅助免疫治疗的潜在候选者） ，以及那些不适合辅助免疫治疗的人。我们使用 Kaplan-Meier 曲线来评估肿瘤学结果，特别是非尿路上皮道无复发生存期 (NUTRFS)、癌症特异性生存期 (CSS) 和总生存期 (OS)。通过 Cox 回归分析确定危险因素。 Kaplan-Meier 曲线显示，在每个 UCB 和 UTUC 组中，潜在辅助免疫治疗候选者的 NUTRFS、CSS 和 OS 显着低于非候选者。 UBC 或 UTUC 辅助免疫治疗候选者之间的 NUTRFS、CSS 和 OS 没有显着差异。不适合接受辅助免疫治疗的患者的趋势相似。多变量分析显示，病理 T 分期（pT3-4 或 ypT2-4）、病理 N 分期和淋巴血管侵犯（LVI）是肿瘤学结果的独立预测因子。 CheckMate 274 试验中的辅助免疫治疗候选标准也可以有效地对根治性手术后的 UC 患者进行分层。 LVI 状态以及病理 T 和 N 状态具有重要的临床意义，表明在选择合适的辅助免疫治疗候选者时应考虑 LVI 状态。