Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Biostatistics Center, Kurume University School of Medicine, Fukuoka, Japan.
Thorac Cancer. 2023 May;14(15):1362-1367. doi: 10.1111/1759-7714.14881. Epub 2023 Apr 10.
The presence of cachexia in cancer patients negatively affects the quality of life and survival. However, the impact of cachexia on immunotherapy, such as PD-1/L1 inhibitors, is not fully understood. Therefore, we examined whether cancer cachexia affects the prognosis of patients with non-small cell lung cancer (NSCLC) treated with PD-1/PD-L1 inhibitors.
We retrospectively screened patients with pathologically confirmed advanced or recurrent NSCLC who were treated with PD-1/PD-L1 monotherapy at Kurume University Hospital. We defined cancer cachexia as weight loss of at least 5% during the past 6 months or any degree of weight loss more than 2% and BMI <20.
Among 182 patients, 74 had cancer cachexia. The presence of cachexia was significantly associated with females, poor performance status (PS), never-smokers, and driver mutations. Multivariate analysis revealed that poor PS and being a smoker were associated with the presence of cachexia. Patients with cancer cachexia had significantly shorter progression-free survival (PFS) and overall survival (OS). In the multivariate analysis, PS and sex were significantly correlated with PFS, whereas PS and cachexia were significantly correlated with OS. Subanalysis revealed that patients in the PS0/without cachexia group had longer PFS and OS than those in the cachexia or PS1-3 group.
In NSCLC patients, cachexia was associated with a worse prognosis, irrespective of tumor PD-L1 expression, indicating that cachexia is a predictive factor for NSCLC patients receiving immune checkpoint inhibitors.
癌症患者出现恶病质会降低生活质量和生存率。然而，恶病质对免疫疗法（如 PD-1/L1 抑制剂）的影响尚未完全阐明。因此，我们研究了恶病质是否会影响接受 PD-1/PD-L1 抑制剂治疗的非小细胞肺癌（NSCLC）患者的预后。
我们回顾性筛选了在久留米大学医院接受 PD-1/PD-L1 单药治疗的经病理证实的晚期或复发性 NSCLC 患者。我们将癌症恶病质定义为过去 6 个月内体重减轻至少 5%或体重减轻超过 2%且 BMI<20。
在 182 例患者中，有 74 例存在癌症恶病质。恶病质的存在与女性、较差的体力状态（PS）、从不吸烟和驱动突变显著相关。多变量分析显示，较差的 PS 和吸烟与恶病质的存在相关。有恶病质的患者无进展生存期（PFS）和总生存期（OS）明显缩短。多变量分析显示，PS 和性别与 PFS 显著相关，而 PS 和恶病质与 OS 显著相关。亚组分析显示，PS0/无恶病质组的患者 PFS 和 OS 长于恶病质或 PS1-3 组。
在 NSCLC 患者中，恶病质与预后较差相关，而与肿瘤 PD-L1 表达无关，表明恶病质是接受免疫检查点抑制剂治疗的 NSCLC 患者的预测因素。
