Department of Oncology, Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Oncologist. 2023 Sep 7;28(9):812-822. doi: 10.1093/oncolo/oyad073.
Risk stratification tools for patients with advanced melanoma (AM) treated with immune checkpoint inhibitors (ICI) are lacking. We identified a new prognostic model associated with overall survival (OS).
A total of 318 treatment naïve patients with AM receiving ICI were collected from a multi-centre retrospective cohort study. LASSO Cox regression identified independent prognostic factors associated with OS. Model validation was carried out on 500 iterations of bootstrapped samples. Harrel's C-index was calculated and internally validated to outline the model's discriminatory performance. External validation was carried out in 142 advanced melanoma patients receiving ICI in later lines.
High white blood cell count (WBC), high lactate dehydrogenase (LDH), low albumin, Eastern Cooperative Oncology Group (ECOG) performance status ≥1, and the presence of liver metastases were included in the model. Patients were parsed into 3 risk groups: favorable (0-1 factors) OS of 52.9 months, intermediate (2-3 factors) OS 13.0 months, and poor (≥4 factors) OS 2.7 months. The C-index of the model from the discovery cohort was 0.69. External validation in later-lines (N = 142) of therapy demonstrated a c-index of 0.65.
Liver metastases, low albumin, high LDH, high WBC, and ECOG≥1 can be combined into a prognostic model for AM patients treated with ICI.
缺乏用于接受免疫检查点抑制剂（ICI）治疗的晚期黑色素瘤（AM）患者的风险分层工具。我们确定了一个与总生存期（OS）相关的新预后模型。
从一项多中心回顾性队列研究中收集了 318 名接受 ICI 治疗的初治 AM 患者。LASSO Cox 回归确定了与 OS 相关的独立预后因素。在 500 次 bootstrap 样本的验证中进行了模型验证。计算并内部验证了 Harrell's C 指数，以概述模型的区分性能。在接受 ICI 后线治疗的 142 名晚期黑色素瘤患者中进行了外部验证。
高白细胞计数（WBC）、高乳酸脱氢酶（LDH）、低白蛋白、东部合作肿瘤学组（ECOG）表现状态≥1 和肝转移存在于模型中。患者被分为 3 个风险组：预后良好（0-1 个因素）的 OS 为 52.9 个月，中等（2-3 个因素）的 OS 为 13.0 个月，预后差（≥4 个因素）的 OS 为 2.7 个月。来自发现队列的模型 C 指数为 0.69。在后续治疗的晚期队列（N=142）中进行的外部验证，c 指数为 0.65。
肝转移、低白蛋白、高 LDH、高 WBC 和 ECOG≥1 可组合成接受 ICI 治疗的 AM 患者的预后模型。
