基于 CT 的体成分与接受免疫治疗的转移性肾细胞癌患者生存的相关性：一项多中心回顾性研究。
Association of computed tomography-based body composition with survival in metastatic renal cancer patient received immunotherapy: a multicenter, retrospective study.
机构信息
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.
出版信息
Eur Radiol. 2023 May;33(5):3232-3242. doi: 10.1007/s00330-022-09345-7. Epub 2022 Dec 20.
OBJECTIVES
To investigate the association of computed tomography-assessed body composition with survival outcomes of metastatic renal cell carcinoma (mRCC) received immunotherapy.
METHODS
In this multicenter, retrospective study, we reviewed 251 mRCC patients who received anti-PD1 from five centers. We analyzed the relationship between BMI, skeletal muscle area (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and subcutaneous adipose percentage (SAT%) with progression-free survival (PFS) and overall survival (OS). The spatial localization T cells was investigated by multiplex immunofluorescence.
RESULTS
Among 224 evaluable patients, 23 (10.3%) patients were underweight, 118 (52.7%) had normal weight, 65 (29%) were overweight, and 18 patients (8%) were obese. The median age was 55 years and most patients were male (71%). No significant improvement in PFS (HR, 0.61; 95% CI, 0.27-1.42) or OS (HR, 1.09; 95% CI, 0.38-3.13) was observed for the obese patients. Besides, SM, VAT, and SAT were not associated with survival outcomes (all p > 0.05). Interestingly, SAT% independently predicted PFS (as continuous variable, HR: 0.02; 95% CI, 0.01-0.11) and OS (HR:0.05; 95% CI, 0.01-0.39), which remained significant in multivariate modeling (as continuous variable, adjusted HR for PFS, 0.01; 95% CI, 0.00-0.04; adjusted HR for OS, 0.08; 95% CI, 0.01-0.72). These associations were consistent in subgroup analysis of different gender, BMI, PD-L1 positive, and sarcopenia group. Tumor of high SAT% patients had a higher intratumoral PD1 CD8 T cell density and ratio.
CONCLUSION
High SAT% predicts better outcomes in mRCC patients treated with anti-PD1 and T cell location may account for the better response.
KEY POINTS
• CT-based subcutaneous adipose percentage independently predicted progression-free survival and overall survival. • Patients with a higher subcutaneous adipose percentage had a higher intratumoral PD1 CD8 T cell density and ratio.
目的
研究计算机断层扫描评估的身体成分与接受免疫治疗的转移性肾细胞癌（mRCC）患者生存结局的关系。
方法
在这项多中心回顾性研究中，我们对来自五个中心的 251 名接受抗 PD-1 治疗的 mRCC 患者进行了回顾性分析。我们分析了 BMI、骨骼肌面积（SM）、皮下脂肪组织（SAT）、内脏脂肪组织（VAT）和皮下脂肪百分比（SAT%）与无进展生存期（PFS）和总生存期（OS）之间的关系。通过多重免疫荧光法研究了空间定位 T 细胞。
结果
在 224 名可评估的患者中，23 名（10.3%）患者体重不足，118 名（52.7%）患者体重正常，65 名（29%）患者超重，18 名（8%）患者肥胖。中位年龄为 55 岁，大多数患者为男性（71%）。肥胖患者的 PFS（HR，0.61；95%CI，0.27-1.42）或 OS（HR，1.09；95%CI，0.38-3.13）均无显著改善。此外，SM、VAT 和 SAT 与生存结局无关（均 P>0.05）。有趣的是，SAT% 独立预测 PFS（作为连续变量，HR：0.02；95%CI，0.01-0.11）和 OS（HR：0.05；95%CI，0.01-0.39），在多变量模型中仍然具有显著意义（作为连续变量，调整后的 PFS 风险比为 0.01；95%CI，0.00-0.04；调整后的 OS 风险比为 0.08；95%CI，0.01-0.72）。这些关联在不同性别、BMI、PD-L1 阳性和肌肉减少症组的亚组分析中是一致的。SAT% 较高的肿瘤患者肿瘤内 PD1 CD8 T 细胞密度和比例更高。
结论
高 SAT% 可预测接受抗 PD-1 治疗的 mRCC 患者的预后更好，T 细胞位置可能是导致更好反应的原因。
关键点
• CT 基于的皮下脂肪百分比独立预测无进展生存期和总生存期。• SAT% 较高的患者肿瘤内 PD1 CD8 T 细胞密度和比例更高。
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