Jiang Yizhen, Tu Xiaoxuan, Zhang Xiangying, Liao Haihong, Han Shuwen, Jiang Weiqin, Zheng Yi, Zhao Peng, Tong Zhou, Fu Qihan, Qi Quan, Shen Junjun, Zhong Liping, Pan Yuefen, Fang Weijia
Department of Medical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China.
Department of Medical Oncology, Huzhou Central Hospital, Huzhou, 313000, Zhejiang, People's Republic of China.
Support Care Cancer. 2020 Nov;28(11):5569-5579. doi: 10.1007/s00520-020-05478-x. Epub 2020 May 2.
The aim of this study was to evaluate the nutrition and metabolism status alteration during immunotherapy in advanced hepatocellular carcinoma (HCC) patients.
Patients with advanced HCC who participated in the clinical trials of single-agent anti-PD-1 immunotherapy or sorafenib were retrospectively included. We analyzed self-comparison of the nutritional and metabolic indices of patients in the anti-PD-1 and sorafenib treatment group. We conducted mutual-comparison of the mentioned indices between the disease progression group and disease control group among anti-PD-1 treatment patients. We further analyzed those indices with statistical differences by partial correlation and survival analysis.
Both self-comparison before and after treatment in the anti-PD-1 group and mutual-comparison of disease progression and the control group showed significant differences in multiple indices, but we did not observe significant differences in the sorafenib group. Strikingly, albumin (ALB)/prognostic nutritional index (PNI, calculated by serum albumin and lymphocyte count) decreased distinctly in the immunotherapy disease progression group patients. However, changes in ALB/PNI were not significant in disease progression patients from the sorafenib group or in the disease control patients with immunotherapy. Partial correlation analysis suggested that ALB and PNI were positively correlated with the efficacy of immunotherapy. Furthermore, survival analysis showed that the median progression-free survival and median overall survival of patients in the ALB/PNI decreased group were significantly shorter than those of patients from the ALB/PNI increased group.
Anti-PD-1 immunotherapy might alter the nutritional and metabolic status in advanced HCC patients. We also should pay attention to the nutritional and metabolic status of patients when drug resistance is detected.
本研究旨在评估晚期肝细胞癌（HCC）患者免疫治疗期间营养和代谢状态的变化。
回顾性纳入参加单药抗PD-1免疫治疗或索拉非尼临床试验的晚期HCC患者。我们分析了抗PD-1治疗组和索拉非尼治疗组患者营养和代谢指标的自身比较。我们对抗PD-1治疗患者中疾病进展组和疾病对照组之间的上述指标进行了相互比较。我们通过偏相关分析和生存分析进一步分析了那些有统计学差异的指标。
抗PD-1组治疗前后的自身比较以及疾病进展组与对照组的相互比较均显示多个指标存在显著差异，但索拉非尼组未观察到显著差异。令人惊讶的是，免疫治疗疾病进展组患者的白蛋白（ALB）/预后营养指数（PNI，由血清白蛋白和淋巴细胞计数计算得出）明显下降。然而，索拉非尼组疾病进展患者或免疫治疗疾病对照组患者的ALB/PNI变化不显著。偏相关分析表明，ALB和PNI与免疫治疗疗效呈正相关。此外，生存分析表明，ALB/PNI下降组患者的中位无进展生存期和中位总生存期明显短于ALB/PNI升高组患者。
抗PD-1免疫治疗可能会改变晚期HCC患者的营养和代谢状态。当检测到耐药时，我们也应关注患者的营养和代谢状态。
