Prognostic value of systemic inflammatory markers in avelumab maintenance for advanced urothelial carcinoma: the multicentric SAILOR analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Systemic inflammatory indices have been proposed as prognostic biomarkers in several malignancies; however, their role in patients receiving avelumab maintenance for advanced urothelial carcinoma (aUC) remains poorly defined. This study aimed to evaluate the prognostic impact of inflammatory markers in this context and to develop a composite score for outcome stratification. We retrospectively analyzed patients with aUC who were treated with avelumab maintenance therapy. Systemic inflammatory markers - including the neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-eosinophil ratio (NER), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII) - were collected at baseline and after treatment initiation (cycle 3), and changes from baseline to cycle three were analyzed (increase versus stability/decrease). Overall survival (OS), the primary endpoint, was evaluated using Kaplan-Meier and Cox models. A prognostic score was created from the multivariable analysis. Time-dependent Receiver operating characteristics (ROC) analysis was employed to evaluate model discrimination at 6, 12, and 24 months. The prognostic impact on disease control rate (DCR - secondary endpoint) was assessed using logistic regression and ROC curves. A total of 358 patients were included in the study. In the multivariable analysis, high NLR, high NER, low LMR, increasing NLR trend, bone and liver metastases were independently associated with worse OS. These variables were incorporated into a 0-6 point prognostic score, which demonstrated good discrimination (C-index 0.76; AUC at 6, 12, and 24 months: 0.87, 0.75, and 0.73, respectively). The score remained prognostic across subgroups and following sensitivity analyses. High LMR, low NER, the absence of liver metastases, and the absence of bone metastases were independently associated with higher DCR. A response-associated score combining these variables showed a decreasing DCR from 69% (score 0) to 25% (score 4). Baseline and dynamic inflammatory markers may serve as prognostic factors for OS in patients with aUC undergoing avelumab maintenance therapy. A composite score that integrates laboratory and clinical features could allow for clinically meaningful stratification of survival and response outcomes, with potential applications in clinical practice. However, a prospective evaluation is necessary.
Source: Scientific Reports
Authors: Brigida Anna Maiorano, Giandomenico Roviello, Alessandro Rizzo, Francesco Ciccimarra, Marco Maruzzo, Francesco Pierantoni, Carlo Messina, Marco Messina, Martina Fanelli, Antonello Veccia, Mimma Rizzo, Alessia Cavo, Vincenza Conteduca, Vincenzo Emanuele Chiuri, Linda Cerbone, Michela Roberto, Federico Paolieri, Daniele Galanti, Gian Paolo Spinelli, Alessia Mennitto, Marco Pisino, Roberto Filippi, Valentina Guadalupi, Maria Cossu Rocca, Pierangela Sepe, Palma Fedele, Michele Dionese, Simona Secondino, Sara Elena Rebuzzi, Francesca Vignani, Mariella Sorarù, Antonio Doronzo, Martina Catalano, Elisabetta Gambale, Daniele Santini, Matteo Santoni, Massimo Di Maio, Lorenzo Antonuzzo, Andrea Necchi
Institutions: IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, University of Florence, Istituto Tumori Bari, Istituto Oncologico Veneto, University of Udine, Ospedale Santa Chiara, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Ospedale Villa Scassi, University of Foggia, Ospedali Riuniti di Foggia, Instituto Nazionale Tumori Regina Elena, Policlinico Umberto I, Sapienza University of Rome, Hospital of Prato, Ospedale Buccheri la Ferla Fatebenefratelli, Azienda Ospedaliero Universitaria Maggiore della Carita, Ospedale Vito Fazzi, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Fondazione IRCCS Istituto Nazionale dei Tumori, European Institute of Oncology, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, Policlinico San Matteo Fondazione, A. O. Ordine Mauriziano di Torino, Ospedale di Macerata, University of Turin, Azienda Ospedaliero-Universitaria Careggi, Vita-Salute San Raffaele University
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W7165044915
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