免疫检查点抑制剂获批前后不同原发部位转移性尿路上皮癌患者预后的差异：基于SEER数据库的队列研究

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ABSTRACT：ObjectiveTo compare the impact of diferent primary tumor sites on the survival of patients with metastatic urothelialcarcinoma（mUC）beforeand after the approvalof immune checkpoints inhibitors（ICIs）basedon data from Surveillance，Epidemiology，andEndResults （SEER）.MethodsThe mUCcases during 2O13and2017 in the SEER database were enroled.Cohortswere definedbyprimarytumorsites（renalpelvis，ureter，bladder）and thenstratified by ICIs availabilityintonon-ICIs era（Ol3）andICIsera（2O17）．Thesurvivaldifferences ineachcohortbetweenthetwo eras were compared，andstratifiedanalysiswas performed.The2-yearoverallsurvival（OS）wasasessedusingKaplan-Meieranalysisand multivariable Cox proportional hazards analysis. ResultsA total of 1750mUC cases were enrolled，with 785 cases in the nonICIs eraand965intheICIsera.Nosignificantdiferences existedacrosdiferentanatomicalsites inthenon-ICIs erahether in the whole urinary system or inside bladder. The 2-year survival rates were 23.5% for ureteral cancer， 18.0% for renal pelvic cancer，and 15.9% for bladder cancer. Significant prognostic disparities emerged among patients based on primary tumor sites inICIsera（ P<0.05; ）.The 2-year survival rates were 37.7% for ureteral cancer， 25.5% for renal pelvic cancer，and 25.7% （20 for bladdercancer.Further analysis revealed thattheOSof the lesions originating from the bladder dome was significantly longer than that of the other bladder subgroups （ P<0.05） ，while the OS of the lesions in bladder bottom was the shortest. The 2-year survival rates were 52.0% forthe bladder dome， 13.0% forthe bladder body，and 10.7% forthe bladder bottom. ConclusionOur study indicates that in the non-ICIs era，there was no significant diference in the prognosis among mUC patients with lesionsfrom diferent primarysites.Inthe ICIs era，theOSof ureteralcancerwassgnificantlylongerthanthatof bladdercancerandrenal pelviscancer.As for patients with metastatic bladdercancer，thosewith tumor locatedatthe topof the bladder had a significantly better prognosis than those with tumors at other sites.

KEY WORDS： blader cancer；metastatic urothelial carcinoma；immunotherapy；immune checkpoints inhibitors；primary site of tumor

摘要：目的使用监测、流行病学和最终结果（SEER）数据库数据比较免疫检查点抑制剂（ICIs）获批前后不同原发肿瘤部位转移性尿路上皮癌（mUC）预后的差异。（剩余11831字）