Department of Medical Oncology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima minamimachi Chuo-ku, Kobe-shi, Hyogo-ken, 650-0047, Japan.
Cancer Treatment Center, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata-shi, Osaka-fu, 573-1191, Japan.
Cancer Immunol Immunother. 2023 Feb;72(2):427-435. doi: 10.1007/s00262-022-03265-7. Epub 2022 Aug 4.
In Japan, nivolumab administration is the standard treatment for patients with unresectable advanced or recurrent esophageal squamous cell carcinoma (ESCC) who are refractory or intolerant to fluoropyrimidines and platinum-based chemotherapy. We determined if inflammatory prognostic factors are useful in patients with ESCC treated with nivolumab monotherapy.
The clinical data of patients with ESCC treated with nivolumab monotherapy as the second- or later-line treatment were retrospectively analyzed. Neutrophil/lymphocyte, platelet/lymphocyte, and C-reactive protein/albumin ratios (CAR); prognostic index; and prognostic nutritional index were investigated. Cut-off values for each factor were determined according to overall survival using time-dependent receiver operating characteristic curves.
During January 2017-June 2021, 93 consecutive patients with ESCC were enrolled from five institutions (median age, 70 years; male, 77%). With a median follow-up period of 9.1 (range, 1.0-34.7) months, the median overall and progression-free survival were 12.8 (95% confidence interval [CI], 9.0-16.6) and 4.0 (95% CI, 2.6-5.4) months, respectively. Of five inflammatory prognostic factors, the cut-off value for CAR was 0.62; prognosis was significantly longer in those with CAR < 0.62 (hazard ratio, 0.39; 95% CI, 0.22-0.67; p = 0.001).
Inflammatory prognostic factors were useful in predicting prognosis for ESCC patients pretreated with nivolumab, especially for those with CAR < 0.62, suggesting that CAR adequately reflects prognosis.
在日本，对于氟嘧啶和铂类化疗不耐受或难治的不可切除的晚期或复发性食管鳞癌（ESCC）患者，nivolumab 给药是标准治疗方法。我们确定炎症预后因素是否对接受 nivolumab 单药治疗的 ESCC 患者有用。
回顾性分析了接受 nivolumab 单药治疗作为二线或更后线治疗的 ESCC 患者的临床数据。研究了中性粒细胞/淋巴细胞、血小板/淋巴细胞和 C 反应蛋白/白蛋白比值（CAR）、预后指数和预后营养指数。根据总生存期使用时间依赖性接受者操作特征曲线确定每个因素的截止值。
2017 年 1 月至 2021 年 6 月，来自五个机构的 93 例连续 ESCC 患者入组（中位年龄为 70 岁；男性占 77%）。中位随访时间为 9.1（范围为 1.0-34.7）个月，中位总生存期和无进展生存期分别为 12.8（95%置信区间 [CI]，9.0-16.6）和 4.0（95% CI，2.6-5.4）个月。在五个炎症预后因素中，CAR 的截止值为 0.62；CAR<0.62 的患者预后显著更长（风险比，0.39；95% CI，0.22-0.67；p=0.001）。
炎症预后因素可用于预测接受 nivolumab 预处理的 ESCC 患者的预后，特别是对于 CAR<0.62 的患者，提示 CAR 充分反映了预后。
