Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
Cancer Immunol Immunother. 2020 Dec;69(12):2413-2424. doi: 10.1007/s00262-020-02680-y. Epub 2020 Aug 4.
This systematic review and meta-analysis aimed to evaluate the association between pretreatment body mass index (BMI) and clinical outcomes in cancer patients treated with immune checkpoint inhibitors (ICIs).
Systematical searches of PubMed, Embase, and the Cochrane Library databases were carried out. Studies reporting on the association between BMI and outcomes of ICIs were included. The intended outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and immune-related adverse events (irAEs). Quantitative analyses and dose-response meta-analyses were performed under random effect models.
Twenty-two eligible studies involving 5686 cancer patients treated with ICIs were identified. Compared to those with lower BMI, patients with higher BMI obtained a significant benefit on OS (HR = 0.698, 95% CI 0.614-0.794, P < 0.001; I = 45.9%) and PFS (HR = 0.760, 95% CI 0.672-0.861, P < 0.001; I = 37.9%). Most stratified analyses for OS and PFS also showed similar pooled risk estimates. For an increment of every 5 kg/m in BMI, the risk for death reduced by approximately 15.6% (HR = 0.844, 95% CI 0.752-0.945, P = 0.003). Moreover, patients with higher BMI had a remarkably better ORR (OR = 0.468, 95% CI 0.263-0.833, P = 0.010; I = 73.6%) than that of those with lower BMI. However, no statistically significant differences were found in the incidence of any grade irAEs (P = 0.073) and ≥ 3 grade irAEs (P = 0.105) between higher and lower BMI.
Higher BMI is significantly associated with improved outcomes in patients treated with ICIs. Further large-scale prospective research is warranted to better illuminate the association between BMI and outcomes from ICIs.
本系统评价和荟萃分析旨在评估癌症患者接受免疫检查点抑制剂（ICI）治疗前的体重指数（BMI）与临床结局之间的关联。
系统检索了 PubMed、Embase 和 Cochrane 图书馆数据库，纳入了报告 BMI 与 ICI 结局之间关系的研究。主要结局包括总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）和免疫相关不良事件（irAEs）。采用随机效应模型进行定量分析和剂量反应荟萃分析。
共纳入 22 项研究，涉及 5686 例接受 ICI 治疗的癌症患者。与 BMI 较低的患者相比，BMI 较高的患者在 OS（HR=0.698，95%CI 0.614-0.794，P<0.001；I=45.9%）和 PFS（HR=0.760，95%CI 0.672-0.861，P<0.001；I=37.9%）方面获益更显著。OS 和 PFS 的大多数分层分析也显示了相似的汇总风险估计值。BMI 每增加 5 kg/m2，死亡风险降低约 15.6%（HR=0.844，95%CI 0.752-0.945，P=0.003）。此外，BMI 较高的患者 ORR 显著优于 BMI 较低的患者（OR=0.468，95%CI 0.263-0.833，P=0.010；I=73.6%）。然而，BMI 较高与较低的患者之间在任何级别 irAEs（P=0.073）和≥3 级 irAEs（P=0.105）的发生率方面无统计学差异。
较高的 BMI 与接受 ICI 治疗的患者的临床结局显著改善相关。需要进一步进行大规模前瞻性研究，以更好地阐明 BMI 与 ICI 结局之间的关系。
