Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.
Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Oncologist. 2020 Mar;25(3):e528-e535. doi: 10.1634/theoncologist.2019-0751. Epub 2019 Dec 5.
Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy.
We performed a retrospective review of 90 patients enrolled on immunotherapy-based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias-adjusted log-rank test. A four-level risk stratification was used to create low-risk (PLR <242 and nonsarcopenic), intermediate-risk (PLR <242 and sarcopenic), high-risk (PLR ≥242 and nonsarcopenic), and very-high-risk (PLR ≥242 and sarcopenic) groups with subsequent association with survival.
Most patients (59%) were male, and the most common cancers were melanoma (33%) and gastrointestinal (22%). Very high-risk, high-risk, and intermediate-risk patients had significantly shorter overall survival (hazard ratio [HR], 8.46; 95% confidence interval [CI], 2.65-27.01; p < .001; HR, 5.32; CI, 1.96-14.43; p = .001; and HR, 4.01; CI, 1.66-9.68; p = .002, respectively) and progression-free survival (HR, 12.29; CI, 5.15-29.32; p < .001; HR, 3.51; CI, 1.37-9.02; p = .009; and HR, 2.14; CI, 1.12-4.10; p = .022, respectively) compared with low-risk patients.
Baseline sarcopenia and elevated inflammatory biomarkers may have a combined effect on decreasing survival in immunotherapy-treated patients in phase I trials. These data may be immediately applicable for medical oncologists for the risk stratification of patients beginning immunotherapeutic agents.
Sarcopenia and inflammation have been associated with poor survival in patients with cancer, but it is unclear how to apply this information to patient care. The authors created a risk-stratification system that combined sarcopenia and platelet-to-lymphocyte ratio as a marker of systemic inflammation. The presence of sarcopenia and systemic inflammation decreased progression-free survival and overall survival in our cohort of 90 patients who received immunotherapy in phase I clinical trials. The data presented in this study may be immediately applicable for medical oncologists as a way to risk-stratify patients who are beginning treatment with immunotherapy.
肌肉减少症和炎症与癌症患者的不良预后相关。我们探讨了这些变量在接受免疫治疗的癌症患者生存中的联合影响。
我们对 2009 年至 2017 年在埃默里大学接受基于免疫疗法的 I 期临床试验的 90 例患者进行了回顾性分析。中性粒细胞与淋巴细胞比值、单核细胞与淋巴细胞比值和血小板与淋巴细胞比值（PLR）被用作炎症的替代标志物。骨骼肌指数（SMI）是从基线腹部 CT 图像中计算出的骨骼肌密度得出的。通过偏倚调整对数秩检验确定连续炎症生物标志物和 SMI 的最佳截断值。采用四级风险分层方法创建低风险（PLR＜242 且非肌肉减少症）、中风险（PLR＜242 且肌肉减少症）、高风险（PLR≥242 且非肌肉减少症）和极高风险（PLR≥242 且肌肉减少症）组，随后与生存相关。
大多数患者（59%）为男性，最常见的癌症是黑色素瘤（33%）和胃肠道（22%）。极高风险、高风险和中风险患者的总生存（危险比[HR]，8.46；95%置信区间[CI]，2.65-27.01；p＜.001；HR，5.32；CI，1.96-14.43；p=.001；HR，4.01；CI，1.66-9.68；p=.002）和无进展生存（HR，12.29；CI，5.15-29.32；p＜.001；HR，3.51；CI，1.37-9.02；p=.009；HR，2.14；CI，1.12-4.10；p=.022）均明显短于低风险患者。
基线肌肉减少症和升高的炎症生物标志物可能对 I 期试验中接受免疫治疗的患者的生存产生联合影响。这些数据可能立即适用于肿瘤内科医生，用于分层开始免疫治疗药物的患者。
肌肉减少症和炎症与癌症患者的不良预后相关，但尚不清楚如何将这些信息应用于患者护理。作者创建了一种风险分层系统，将肌肉减少症和血小板与淋巴细胞比值（PLR）作为全身性炎症的标志物结合起来。在我们的 90 名接受 I 期临床试验免疫治疗的患者队列中，存在肌肉减少症和全身炎症降低了无进展生存期和总生存期。本研究中提出的数据可能立即适用于肿瘤内科医生，作为一种风险分层方法，用于开始接受免疫治疗的患者。
Zotero 插件
