Post-Treatment NLR and SII Associations with Response and Progression-Free Survival After Neoadjuvant Disitamab Vedotin Plus PD-1 Blockade in Muscle-Invasive Bladder Cancer: A Real-World Cohort Study

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Abstract
Background/Objectives: This study evaluated neoadjuvant disitamab vedotin plus programmed cell death protein 1 (PD-1) blockade and associations of post-treatment neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) with response and progression-free survival (PFS) in muscle-invasive bladder cancer. Methods: This single-center retrospective cohort included 71 patients with cT2–T3N0M0, human epidermal growth factor receptor 2 (HER2)-expressing disease treated between September 2021 and October 2025. Logistic regression and receiver operating characteristic analyses evaluated response endpoints; Kaplan–Meier and Cox methods evaluated PFS. Benjamini–Hochberg correction was applied separately to response analyses. Results: Complete response (CR), objective response, and disease control rates were 66.2%, 84.5%, and 88.7%. Of 47 CRs, 5 were cystectomy-confirmed pathological CR (pCR) and 42 were clinical CR (cCR). Response associations did not remain significant after correction (minimum q = 0.082). AUCs were 0.659–0.708. In a two-variable Cox model based on 14 PFS events, treatment cycles (HR 0.615, 95% CI 0.419–0.903; p = 0.013) and SII per 100 units (HR 1.205, 95% CI 1.073–1.355; p = 0.002) were associated with PFS, but these estimates require cautious interpretation. Two deaths occurred. Conclusions: Neoadjuvant disitamab vedotin plus PD-1 blockade showed promising antitumor activity. The pooled CR endpoint may overestimate pathological response and is not directly comparable with cystectomy-confirmed pCR. Without standardized pretreatment NLR and SII measurements, reverse causality cannot be excluded. Response associations and PFS findings based on 14 events require cautious interpretation and prospective validation.
Funding Information
  • Clinical Research Fund For Distinguished Young Scholars of Peking University Cancer Hospital (QNJJ202204)
  • Beijing Hospitals Authority Youth Programme (QMIL20231114)
  • Beijing Hospitals Authority’s Ascent Plan (DFL20241101)
  • Beijing Natural Science Foundation (L2608069)

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