Department of Oncology, Eugene Marquis Center, Rennes.
Department of Endocrinology, Brest University Hospital, Brest.
Melanoma Res. 2021 Jun 1;31(3):208-217. doi: 10.1097/CMR.0000000000000739.
This study aimed to assess the prognostic value of thyroid dysfunctions in metastatic melanoma patients on anti-programmed death-1 (anti-PD-1). A total of 110 stage IV or inoperable stage III melanoma patients treated with anti-PD-1 alone or in association with anti-CTLA-4 (T-lymphocyte antigen-4) antibody from January 2015 to December 2017 at our institution were enrolled in this retrospective study. Median follow-up was 32.8 months. Transitory thyroid dysfunctions and permanent thyroid dysfunctions were distinguished. The main criterion was progression-free survival. Secondary criteria were best response and overall survival. Survival curves were compared with log-rank tests and a cox proportional hazard ratio model was used to adjust patients and melanoma characteristics. Thirty-eight (35%) thyroid dysfunctions were observed during the follow-up, including 25 transitory thyroid dysfunctions (23%) and 13 permanent thyroid dysfunctions (12%). Progression-free survival was longer in patients with thyroid dysfunction (18.1 months) than in patients without thyroid dysfunction (3.9 months, P = 0.0085). In multivariate analysis, thyroid dysfunctions were not an independent predictive factor for progression-free survival. Patients with thyroid dysfunction had a longer overall survival (P = 0.0021), and thyroid dysfunctions were associated with a lower mortality risk (hazard ratio = 0.40; P = 0.005). Best response was positively associated with thyroid dysfunctions (P = 0.048). Thyroid dysfunctions induced by anti-PD-1 were not an independent predictive factor for progression-free survival in metastatic melanoma patients but seemed associated with a better response and increased overall survival.
这项研究旨在评估甲状腺功能障碍对接受抗程序性死亡-1（抗 PD-1）治疗的转移性黑色素瘤患者的预后价值。本回顾性研究共纳入了 2015 年 1 月至 2017 年 12 月在我院接受抗 PD-1 单药或联合 T 淋巴细胞抗原-4（CTLA-4）抗体治疗的 110 例 IV 期或不可切除 III 期黑色素瘤患者。中位随访时间为 32.8 个月。区分了暂时性甲状腺功能障碍和永久性甲状腺功能障碍。主要标准是无进展生存期。次要标准是最佳反应和总生存期。通过对数秩检验比较生存曲线，并使用 cox 比例风险比模型调整患者和黑色素瘤特征。在随访期间观察到 38 例（35%）甲状腺功能障碍，包括 25 例暂时性甲状腺功能障碍（23%）和 13 例永久性甲状腺功能障碍（12%）。甲状腺功能障碍患者的无进展生存期（18.1 个月）长于无甲状腺功能障碍患者（3.9 个月，P = 0.0085）。多变量分析显示，甲状腺功能障碍不是无进展生存期的独立预测因素。甲状腺功能障碍患者的总生存期更长（P = 0.0021），且甲状腺功能障碍与死亡率降低相关（风险比=0.40；P = 0.005）。最佳反应与甲状腺功能障碍呈正相关（P = 0.048）。抗 PD-1 诱导的甲状腺功能障碍不是转移性黑色素瘤患者无进展生存期的独立预测因素，但似乎与更好的反应和增加的总生存期相关。
