Botticelli Andrea, Cirillo Alessio, Scagnoli Simone, Cerbelli Bruna, Strigari Lidia, Cortellini Alessio, Pizzuti Laura, Vici Patrizia, De Galitiis Federica, Di Pietro Francesca Romana, Cerbelli Edoardo, Ghidini Michele, D'Amati Giulia, Della Rocca Carlo, Mezi Silvia, Gelibter Alain, Giusti Raffaele, Cortesi Enrico, Ascierto Paolo Antonio, Nuti Marianna, Marchetti Paolo
Department of Clinical and molecular oncology, University of Rome "Sapienza", 00185 Rome, Italy.
Department of Radiological, Oncological and anatomo-pathological Science, University of Rome "Sapienza", 00185 Rome, Italy.
Vaccines (Basel). 2020 Apr 28;8(2):203. doi: 10.3390/vaccines8020203.
Immune checkpoint inhibitors have revolutionized treatment and outcome of melanoma and many other solid malignancies including non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC). Unfortunately, only a minority of patients have a long-term benefit, while the remaining demonstrate primary or acquired resistance. Recently, it has been demonstrated that the prevalence of programmed death-ligand 1 (PD-L1) and tumor-infiltrating lymphocytes (TILs) varies based on the anatomical site of metastases. In particular, liver seems to have more immunosuppressive microenvironment while both the presence of lymph nodal disease and lung metastases seem to have the highest prevalence of PD-L1 and TILs. The aim of the present study is to investigate the possible role of site of metastases as a predictive factor for response or resistance to immunotherapy in several types of cancer. In this multicenter retrospective study, we enrolled patients with metastatic NSCLC, melanoma, RCC, urothelial, merkel carcinoma, and colon cancer who received immunotherapy from April 2015 to August 2019. Major clinicopathological parameters were retrieved and correlated with patients' survival outcomes in order to assess their prognostic value and build a useful tool to assist in the decision-making process. A total of 291 patients were included in this study. One hundred eighty-seven (64%) patients were male and 104 (36%) female. The tumor histology was squamous NSCLC in 56 (19%) patients, non-squamous NSCLC in 99 (34%) patients, melanoma in 101 (35%) patients, RCC in 28 (10%) patients, and other tumors in the remaining 7 (2%) patients. The number of metastatic sites was 1 in 103 patients (35%), 2 in 104 patients (36%) and 3 in 84 patients (29%). Out of 183 valuable patients, the entity of response was complete response (CR), partial response (PR), stable disease (SD), and progression disease (PD) in 15, 53, 31, and 79 patients, respectively. Using an univariate analysis (UVA), tumor burden ( = 0.0004), the presence of liver ( = 0.0009), bone ( = 0.0016), brain metastases ( < 0.0001), the other metastatic sites ( = 0.0375), the number of metastatic sites ( = 0.0039), the histology ( = 0.0034), the upfront use of immunotherapy ( = 0.0032), and Eastern Cooperative Oncology Group (ECOG) Perfomance status (PS) ≥ 1 ( < 0.0001) were significantly associated with poor overall survival (OS). Using a multivariate analysis (MVA) the presence of liver ( = 0.0105) and brain ( = 0.0026) metastases, the NSCLC diagnosis ( < 0.0001) and the ECOG PS ( < 0.0001) resulted as significant prognostic factors of survival. Regarding the progression free survival (PFS), using a UVA of the tumor burden ( = 0.0004), bone ( = 0.0098) and brain ( = 0.0038) metastases, the presence of other metastatic sites ( = 0.0063), the number of metastatic sites ( = 0.0007), the histology ( = 0.0007), the use of immunotherapy as first line ( = 0.0031), and the ECOG PS ≥ 1 ( ≤ 0.0001) were associated with a lower PFS rate. Using an MVA, the presence of brain ( = 0.0088) and liver metastases ( = 0.024) and the ECOG PS ( < 0.0001) resulted as predictors of poor PFS. Our study suggests that the site of metastases could have a role as prognostic and predictive factor in patients treated with immunotherapy. Indeed, regardless of the histology, the presence of liver and brain metastases was associated with a shorter PFS and OS, but these results must be confirmed in further studies. In this context, a deep characterization of microenvironment could be crucial to prepare patients through novel strategies with combination or sequential immunotherapy in order to improve treatment response.
免疫检查点抑制剂彻底改变了黑色素瘤以及包括非小细胞肺癌(NSCLC)和肾细胞癌(RCC)在内的许多其他实体恶性肿瘤的治疗方式和治疗结果。不幸的是,只有少数患者能获得长期益处,而其余患者则表现出原发性或获得性耐药。最近,研究表明程序性死亡配体1(PD-L1)和肿瘤浸润淋巴细胞(TILs)的患病率因转移的解剖部位而异。特别是,肝脏似乎具有更强的免疫抑制微环境,而淋巴结疾病和肺转移灶中PD-L1和TILs的患病率似乎最高。本研究的目的是探讨转移部位作为几种癌症免疫治疗反应或耐药预测因素的可能作用。在这项多中心回顾性研究中,我们纳入了2015年4月至2019年8月接受免疫治疗的转移性NSCLC、黑色素瘤、RCC、尿路上皮癌、默克尔细胞癌和结肠癌患者。检索主要临床病理参数并将其与患者的生存结果相关联,以评估其预后价值并构建一个有用的工具来辅助决策过程。本研究共纳入291例患者。187例(64%)为男性,104例(36%)为女性。肿瘤组织学类型为鳞状NSCLC的患者有56例(19%),非鳞状NSCLC的患者有99例(34%),黑色素瘤的患者有101例(35%),RCC的患者有28例(10%),其余7例(2%)为其他肿瘤患者。转移部位数量为1个的患者有103例(35%),2个的患者有104例(36%),3个的患者有84例(29%)。在183例有价值的患者中,反应类型为完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)和疾病进展(PD)的患者分别有15例、53例、31例和79例。采用单因素分析(UVA),肿瘤负荷(P = 0.0004)、肝脏转移(P = 0.0009)、骨转移(P = 0.0016)、脑转移(P < 0.0001)、其他转移部位(P = 0.0375)、转移部位数量(P = 0.0039)、组织学类型(P = 0.0034)、免疫治疗的一线使用情况(P = 0.0032)以及东部肿瘤协作组(ECOG)体能状态(PS)≥1(P < 0.0001)与总生存期(OS)较差显著相关。采用多因素分析(MVA),肝脏转移(P = 0.0105)和脑转移(P = 0.0026)的存在、NSCLC诊断(P < 0.0001)以及ECOG PS(P < 0.0001)是生存的显著预后因素。关于无进展生存期(PFS),采用UVA分析,肿瘤负荷(P = 0.0004)、骨转移(P = 0.0098)和脑转移(P = 0.0038)的存在、其他转移部位的存在(P = 0.0063)、转移部位数量(P = 0.0007)、组织学类型(P = 0.0007)、免疫治疗作为一线治疗的使用情况(P = 0.0031)以及ECOG PS≥1(P ≤ 0.0001)与较低的PFS率相关。采用MVA分析,脑转移(P = 0.0088)和肝脏转移(P = 0.024)的存在以及ECOG PS(P < 0.0001)是PFS较差的预测因素。我们的研究表明,转移部位可能在接受免疫治疗的患者中作为预后和预测因素发挥作用。确实,无论组织学类型如何,肝脏和脑转移的存在均与较短的PFS和OS相关,但这些结果必须在进一步研究中得到证实。在这种情况下,对微环境进行深入表征对于通过联合或序贯免疫治疗的新策略使患者做好准备以改善治疗反应可能至关重要。