Department of Surgery, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
Clin Nutr ESPEN. 2021 Apr;42:348-353. doi: 10.1016/j.clnesp.2021.01.009. Epub 2021 Jan 20.
While immunotherapy agents have improved outcomes in metastatic melanoma (MM), predictive biomarkers in these patients are lacking. Parameters identified from body composition analysis, such as low SMD (also termed myosteatosis), may prognosticate MM patients on immunotherapy.
In this retrospective study, 44 MM patients received nivolumab, either as monotherapy or in combination with ipilimumab. Pre-treatment computed tomography (CT) scans were analyzed to determine skeletal muscle density (SMD) in Hounsfield units (HU) and muscle surface area (MSA) in cm at L3. MSA was used to determine nivolumab dosing in mg/cm.
Low SMD was associated with worse overall survival (OS) by log rank test (median 12.03 vs. 34.96 months, p = 0.001) and in multivariate analysis when accounting for age, sex, performance status, and number of prior lines of therapy (HR 4.40, 95% CI 1.44-13.42, p = 0.009). Lower nivolumab dosing by MSA was significantly associated with improved OS (median 42.9 vs. 12.3 months, p < 0.001). This association remained significant in multivariate analysis with age, sex, performance status, and number of prior lines of therapy (HR 0.05, 95% CI 0.01-0.30, p = 0.001). Neither SMD nor higher nivolumab dose per MSA were associated with increased incidence of treatment toxicity.
Low SMD is prognostic in MM treated with nivolumab immunotherapy. Presence of myosteatosis or higher nivolumab dose based on body composition did not predict treatment toxicity.
免疫疗法在转移性黑色素瘤（MM）中改善了预后，但这些患者缺乏预测性生物标志物。从身体成分分析中确定的参数，如低 SMD（也称为肌脂过多），可能可以预测接受免疫治疗的 MM 患者的预后。
在这项回顾性研究中，44 名 MM 患者接受了纳武单抗治疗，单独使用或与伊匹单抗联合使用。对治疗前的计算机断层扫描（CT）进行分析，以确定 L3 水平的肌肉密度（SMD）（以亨氏单位（HU）表示）和肌肉表面积（MSA）（以平方厘米表示）。MSA 用于确定纳武单抗的剂量（mg/cm）。
对数秩检验显示低 SMD 与总生存期（OS）较差相关（中位 12.03 与 34.96 个月，p=0.001），并且在考虑年龄、性别、表现状态和先前治疗线数的多变量分析中也是如此（HR 4.40，95%CI 1.44-13.42，p=0.009）。MSA 上较低的纳武单抗剂量与改善的 OS 显著相关（中位 42.9 与 12.3 个月，p<0.001）。在考虑年龄、性别、表现状态和先前治疗线数的多变量分析中，这种关联仍然具有统计学意义（HR 0.05，95%CI 0.01-0.30，p=0.001）。SMD 或 MSA 上较高的纳武单抗剂量均与治疗毒性的发生率增加无关。
低 SMD 在接受纳武单抗免疫治疗的 MM 中具有预后意义。肌脂过多的存在或基于身体成分的较高纳武单抗剂量并不能预测治疗毒性。
