Dousset Léa, Pacaud Alize, Barnetche Thomas, Kostine Marie, Dutriaux Caroline, Pham-Ledard Anne, Beylot-Barry Marie, Gérard Emilie, Prey Sorilla, Andreu Nicolas, Boniface Katia, Seneschal Julien
Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France.
Department of Rheumatology, National Reference Center for Severe Systemic Autoimmune Diseases, FHU ACRONIM, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France.
JAAD Int. 2021 Oct 19;5:112-120. doi: 10.1016/j.jdin.2021.09.002. eCollection 2021 Dec.
Clinical factors associated with vitiligo in patients receiving anti-programmed cell death-1 (PD-1) remain unknown.
To better characterize the occurrence of vitiligo in patients receiving anti-PD-1.
The present single-center ambispective cohort study included patients with melanoma treated with anti-PD-1. Progression-free survival, overall survival, and objective tumor response were compared between patients with and those without vitiligo using Kaplan-Meier curves and the log-rank test. Demographic and clinical factors associated with vitiligo were evaluated using multivariate logistic regression.
Of the 457 patients included in the study, vitiligo developed in 85 patients. The clinical presentation of vitiligo consisted of the presence of ovalar and multiple flecked white macules, mainly located on chronic sun-exposed areas. The presence of vitiligo was associated with a significant improvement in overall survival and progression-free survival ( < .001). A Cox proportional hazards model estimation demonstrated markedly improved survival in patients with vitiligo compared with those without vitiligo (aHR [overall survival], 0.20; 95% CI, 0.12-0.33; < .001; and aHR [progression-free survival], 0.33; 95% CI, 0.23-0.47; < .001). In the multivariate logistic regression analyses, men showed an independent increased risk of the development of vitiligo (odds ratio, 1.66). In contrast, the presence of pulmonary metastases was found to be an independent factor associated with a reduced risk of the development of vitiligo (odds ratio, 0.50).
Single-center ambispective cohort.
Vitiligo in patients receiving anti-PD-1 for advanced melanoma is associated with a better outcome. A gender effect associated with the development of vitiligo will need further investigation.
接受抗程序性细胞死亡蛋白1（PD-1）治疗的患者中，与白癜风相关的临床因素尚不清楚。
更好地描述接受抗PD-1治疗的患者中白癜风的发生情况。
本单中心双向队列研究纳入了接受抗PD-1治疗的黑色素瘤患者。使用Kaplan-Meier曲线和对数秩检验比较有白癜风和无白癜风患者的无进展生存期、总生存期和客观肿瘤反应。使用多因素逻辑回归评估与白癜风相关的人口统计学和临床因素。
在纳入研究的457例患者中，85例出现了白癜风。白癜风的临床表现为出现椭圆形和多发性斑点状白色斑片，主要位于长期暴露于阳光下的部位。白癜风的出现与总生存期和无进展生存期的显著改善相关（P<0.001）。Cox比例风险模型估计显示，与无白癜风患者相比，有白癜风患者的生存期明显改善（总生存期的风险比[aHR]，0.20；95%可信区间[CI]，0.12-0.33；P<0.001；无进展生存期的aHR，0.33；95%CI，0.23-0.47；P<0.001）。在多因素逻辑回归分析中，男性发生白癜风的风险独立增加（优势比，1.66）。相反，肺转移的存在是与白癜风发生风险降低相关的独立因素（优势比，0.50）。
单中心双向队列。
接受抗PD-1治疗的晚期黑色素瘤患者出现白癜风与较好的预后相关。白癜风发生的性别效应需要进一步研究。
