Predicting outcomes with pembrolizumab: a meta-analysis of pre-treatment hematological and clinical prognostic factors in advanced/metastatic urothelial carcinoma

Introduction: Recent studies have shown the therapeutic benefits of pembrolizumab in locally advanced or metastatic urothelial carcinoma (mUC). However, its high cost and variable patient responses remain challenges. This study aims to investigate the prognostic value of pre-treatment hematologic and clinical parameters in predicting outcomes in mUC patients.
Methods: A comprehensive search was conducted across five databases for relevant articles. Studies that assessed the relationship between pre-treatment hematological and clinical parameters and either progression free survival (PFS) or overall survival (OS) were included and evaluated for bias.
Results: The literature search identified 27 studies encompassing a total of 4,731 patients. Several prognostic factors linked to OS were identified, with the most adverse survival outcomes associated with hypoalbuminemia (HR 3.13, 95% CI: 2.52-3.88), ECOG-PS ≥2 (HR 2.94, 95% CI: 2.65-3.26), and the presence of liver metastasis (HR 2.44, 95% CI: 2.16-2.76). Additionally, the presence of bone, liver, or lung metastases, ECOG-PS ≥ 2, surgical excision of the primary tumor, elevated C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), and low hemoglobin levels were all correlated with unfavorable PFS and OS.
Conclusions: Patients with metastatic urothelial carcinoma and poor performance status, visceral metastases, high NLR or CRP, or low hemoglobin may have poorer survival, even with pembrolizumab. These factors may help guide clinical decisions for patients with advanced/metastatic urothelial carcinoma.

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