Background/Objective: The impact of adjuvant immunotherapy (IO) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) remains unclear. This study examines the association of adjuvant IO with oncologic outcomes in patients with high-risk UTUC.Methods: This retrospective study reviewed patients with high-risk UTUC treated with adjuvant IO using the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) database. Propensity-score-matched analysis (nearest-neighbor algorithm, caliper 0.1) was conducted to compare patients receiving adjuvant IO versus those who did not, with matching based on pathologic T and N category and receipt of neoadjuvant chemotherapy. Associations between adjuvant IO and urothelial recurrence-free survival (URFS), non-urothelial recurrence-free survival (NRFS), and overall survival (OS) were estimated using a Cox proportional hazards model.Results: Seventy-five patients received adjuvant IO following nephroureterectomy (median four cycles, including eleven (14.7%) nivolumab, thirty-one (41.3%) pembrolizumab, four (5.3%) atezolizumab, and twenty-nine (38.6%) other agents. These patients were matched to 68 patients without adjuvant therapy. Median follow-up times were 17 (IQR, 10–29) months and 20 (9–44) months for IO and no adjuvant therapy, respectively. Multivariable analysis revealed that adjuvant IO was not associated with URFS, NRFS, or OS. Pathologic nodal involvement (HR 7.52,p< 0.001) was the only independent predictor of worse OS.Conclusions: In this real-world retrospective data set, adjuvant IO does not have an impact on oncologic outcomes of UTUC patients following extirpative surgery.
背景/目的：辅助免疫治疗对上尿路尿路上皮癌患者预后的影响尚不明确。本研究旨在探讨辅助免疫治疗与高危UTUC患者肿瘤学结局的关联性。 方法：本研究通过回顾性分析ROBUUST数据库中接受辅助免疫治疗的高危UTUC患者。采用倾向性评分匹配分析（最近邻算法，卡钳值0.1），根据病理T/N分期及新辅助化疗接受情况，将接受辅助免疫治疗的患者与未接受辅助治疗的患者进行匹配。通过Cox比例风险模型评估辅助免疫治疗与尿路上皮无复发生存期、非尿路上皮无复发生存期及总生存期的关联。 结果：75例患者在肾输尿管切除术后接受辅助免疫治疗（中位周期数4次，其中纳武利尤单抗11例[14.7%]、帕博利珠单抗31例[41.3%]、阿特珠单抗4例[5.3%]、其他药物29例[38.6%]）。这些患者与68例未接受辅助治疗的患者完成匹配。免疫治疗组与无辅助治疗组的中位随访时间分别为17个月（IQR 10-29）和20个月（9-44）。多变量分析显示辅助免疫治疗与URFS、NRFS或OS均无显著关联。病理淋巴结转移是OS恶化的唯一独立预测因素（HR 7.52，p<0.001）。 结论：在这项真实世界回顾性数据集中，辅助免疫治疗对UTUC患者根治性手术后的肿瘤学结局未产生显著影响。
肿瘤(癌症)患者之家