The University of Oklahoma, Oklahoma City, OK, USA.
NRG Oncology Statistical and Data Center, Roswell Park Cancer Institute, University of Buffalo, Buffalo, NY, USA.
Gynecol Oncol. 2019 Oct;155(1):69-74. doi: 10.1016/j.ygyno.2019.07.020. Epub 2019 Aug 10.
Adiposity has been hypothesized to interfere with the activity of bevacizumab (BEV), an anti-angiogenic agent. Measurements of adiposity, BMI, surface fat area (SFA), and visceral fat area (VFA) were investigated as prognostic of oncologic outcomes among patients treated with chemotherapy, with or without BEV, on GOG 218, a prospective phase III trial.
Pretreatment computed tomography (CT) for 1538 GOG 218 participants were analyzed. Proportional hazards models assessed association between adiposity and overall survival (OS) adjusted for other prognostic factors. The predictive value of adiposity as a function of BEV treatment was assessed in 1019 patients randomized to either chemotherapy (CT) + placebo (P) → P or CT + BEV → BEV.
After adjusting for prognostic factors, SFA was not associated with the overall hazard of death (p = 0.981). There was a non-significant 0.1% (p = 0.062) increase in hazard of death associated with a unit increase in VFA. When comparing the treatment HRs for patients who did and did not receive BEV, there was no association with SFA (p = 0.890) or VFA (p = 0.106). A non-significant 0.8% increase in the hazard of death with unit increase in BMI (p = 0.086) was observed. BMI values were not predictive of a longer survival for patients with BEV vs placebo (p = 0.606).
Measures of adiposity strongly correlated to one another but were not predictive of efficacy for BEV. VFA is a weak prognostic factor.
人们推测肥胖会干扰贝伐珠单抗（bevacizumab，BEV）的活性，后者是一种抗血管生成药物。在 GOG 218 前瞻性 III 期试验中，对接受化疗联合或不联合 BEV 治疗的患者，研究了肥胖指标、体重指数（BMI）、体表面积脂肪（SFA）和内脏脂肪面积（VFA）与肿瘤结局的相关性。
分析了 1538 名 GOG 218 参与者的预处理计算机断层扫描（CT）。比例风险模型评估了肥胖与其他预后因素调整后的总生存期（OS）之间的相关性。在 1019 名随机分配至化疗（CT）+安慰剂（P）→P 或 CT+BEV→BEV 的患者中，评估了肥胖作为 BEV 治疗的预测值。
在调整了预后因素后，SFA 与死亡的总体风险无关（p=0.981）。VFA 每增加一个单位，死亡风险增加 0.1%（p=0.062），但无统计学意义。当比较接受和未接受 BEV 治疗的患者的治疗 HR 时，与 SFA（p=0.890）或 VFA（p=0.106）无关。BMI 每增加一个单位，死亡风险增加 0.8%（p=0.086），但无统计学意义。观察到 BMI 值与 BEV 与安慰剂相比患者的生存时间无关（p=0.606）。
肥胖指标彼此之间具有很强的相关性，但不能预测 BEV 的疗效。VFA 是一个较弱的预后因素。
