Efficacy and safety of combining radiotherapy with first-line chemotherapy and immunotherapy for local advanced/metastatic urothelial cancer: a propensity score matching analysis.
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; P = 0.002) and OS (38.9 vs. 19.8 months; P = 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 (P < 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 (P = 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.
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; P = 0.002) and OS (38.9 vs. 19.8 months; P = 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 (P < 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 (P = 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.
Authors
Qin Qin, Zhou Zhou, Li Li, Yin Yin, Deng Deng, Luo Luo, Chen Chen, Yin Yin, Zhou Zhou, Zhan Zhan, Zheng Zheng, Zhang Zhang, He He
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