患有合并症的患者在接受检查点抑制剂免疫治疗后的毒性和生存与心血管疾病的相关性。
Association of medical comorbidities and cardiovascular disease with toxicity and survival among patients receiving checkpoint inhibitor immunotherapy.
机构信息
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
College of Medicine, The Ohio State University, Columbus, OH, USA.
出版信息
Cancer Immunol Immunother. 2023 Jul;72(7):2005-2013. doi: 10.1007/s00262-023-03371-0. Epub 2023 Feb 4.
BACKGROUND AND OBJECTIVES
Medical comorbidities (MC) are highly prevalent among patients with cancer and predict worse outcomes for traditional therapies. This association is poorly understood for checkpoint inhibitor immunotherapy (IO). We aimed to explore the relationship between common MC including cardiovascular disease (CVD), immune-related adverse events (irAEs), and overall survival (OS) among patients receiving IO for advanced cancer.
METHODS
This is a retrospective cohort study of 671 patients with any cancer who received IO at our institution from 2011 to 2018. Clinical data were abstracted via chart review and query of ICD-10 codes and used to calculate modified Charlson comorbidity index (mCCI) scores. The primary outcomes were the association of individual MC with irAEs and OS using bivariate and multivariable analyses. Secondary outcomes included association of mCCI score with irAEs and OS.
RESULTS
Among 671 patients, 62.1% had a mCCI score ≥ 1. No individual MC were associated with irAEs or OS. Increased CCI score was associated with decreased OS (p < 0.01) but not with irAEs. Grade ≥ 3 irAEs were associated with increased OS among patients without CVD (HR 0.37 [95% CI: 0.25, 0.55], p < 0.01), but not among patients with CVD.
CONCLUSIONS
No specific MC predicted risk of irAEs or OS for patients receiving IO. Increased CCI score did not predict risk of irAEs but was associated with shorter OS. This suggests IO is safe for patients with MC, but MC may limit survival benefits of IO. CVD may predict shorter OS in patients with irAEs and should be evaluated among patients receiving IO.
背景与目的
癌症患者常合并多种医学病症（MC），这些病症与传统疗法的预后不良有关。然而，这种关联在接受检查点抑制剂免疫治疗（IO）的患者中尚未得到充分理解。本研究旨在探讨常见的 MC（包括心血管疾病（CVD）和免疫相关不良事件（irAE））与接受 IO 治疗的晚期癌症患者的总生存期（OS）之间的关系。
方法
这是一项回顾性队列研究，纳入了 2011 年至 2018 年期间在我院接受 IO 治疗的 671 例癌症患者。通过病历回顾和 ICD-10 代码查询获取临床数据，并用于计算改良 Charlson 合并症指数（mCCI）评分。主要结局是使用双变量和多变量分析评估个体 MC 与 irAE 和 OS 的关系。次要结局包括 mCCI 评分与 irAE 和 OS 的关系。
结果
在 671 例患者中，62.1%的患者 mCCI 评分≥1。没有单个 MC 与 irAE 或 OS 相关。CCI 评分升高与 OS 降低相关（p<0.01），但与 irAE 无关。无 CVD 的患者中，发生≥3 级 irAE 与 OS 增加相关（HR 0.37 [95%CI：0.25, 0.55]，p<0.01），而 CVD 患者则无此关联。
结论
没有特定的 MC 可预测接受 IO 治疗的患者发生 irAE 或 OS 的风险。CCI 评分升高不能预测 irAE 的风险，但与 OS 降低相关。这表明 MC 并不影响 IO 的安全性，但可能限制 IO 的生存获益。CVD 可能预示着发生 irAE 的患者 OS 较短，应在接受 IO 治疗的患者中进行评估。
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