Li Depei, Duan Hao, Jiang Pingping, Jiang Xiaobing, He Zhenqiang, Guo Chengcheng, Mou Yonggao
Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center Guangzhou, China.
Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou, China.
Am J Transl Res. 2020 Jul 15;12(7):3767-3779. eCollection 2020.
The approval of immune checkpoint inhibitors (ICI) for metastatic melanoma in 2011 has changed the treatment landscape of this disease. However, current trend of the population-based survival remains unclear.
8078 patients with metastatic melanoma diagnosed in the pre-ICI (2005-2010) and post-ICI period (2011-2016) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) program for survival comparison. Propensity score matching (PSM) was performed to reduce selection bias. Cox proportional hazards model was applied for identifying survival-related factors and constructing a prognostic nomogram. The accuracy of the nomogram was determined by concordance index (C-index), calibration curves, and validated by an internal cohort.
Patients in the post-ICI period had a significantly longer median overall survival (OS) than those in the pre-ICI period, even after performing PSM between the two periods. We also found socioeconomic disparities in the survival improvement. Significant differences in OS between the two periods were only observed in cases with medical insurance and patients living in urban or low-poverty area, but not uninsured cases and patients from rural or high-poverty area. For patients in the post-ICI period, multivariate analysis demonstrated that socioeconomic and insurance status were independent prognostic factors, which can be combined with other clinical variates into a nomogram for OS prediction with promising C-index of 0.672 and 0.650 in the training- and testing cohort, respectively.
An overall trend to favorable survival at the population level and socioeconomic disparities in the survival trend are observed in metastatic melanoma after the ICI approval. The proposed nomogram is available for prognostication in the current melanoma management.
2011年免疫检查点抑制剂（ICI）获批用于治疗转移性黑色素瘤，改变了该疾病的治疗格局。然而，目前基于人群的生存趋势仍不明确。
从监测、流行病学和最终结果（SEER）项目中纳入8078例在ICI治疗前（2005 - 2010年）和ICI治疗后（2011 - 2016年）诊断为转移性黑色素瘤的患者进行生存比较。采用倾向评分匹配（PSM）以减少选择偏倚。应用Cox比例风险模型识别生存相关因素并构建预后列线图。通过一致性指数（C-index）、校准曲线确定列线图的准确性，并在内部队列中进行验证。
即使在两个时期之间进行PSM后，ICI治疗后时期的患者中位总生存期（OS）仍显著长于ICI治疗前时期。我们还发现了生存改善方面的社会经济差异。仅在有医疗保险的患者以及居住在城市或低贫困地区的患者中观察到两个时期之间OS存在显著差异，而在无保险患者以及来自农村或高贫困地区的患者中未观察到。对于ICI治疗后时期的患者，多变量分析表明社会经济和保险状况是独立的预后因素，可将其与其他临床变量结合纳入用于OS预测的列线图，在训练队列和测试队列中的C-index分别为0.672和0.650，前景良好。
ICI获批后，转移性黑色素瘤在人群水平上呈现出总体生存向好的趋势，且生存趋势存在社会经济差异。所提出的列线图可用于当前黑色素瘤管理中的预后评估。
