免疫检查点抑制剂治疗转移性肾细胞癌患者中免疫相关不良事件的预后意义
Prognostic Significance of Immune-related Adverse Events in Metastatic Renal Cell Carcinoma Patients Treated With Immune-checkpoint-inhibitors.
作者信息
Yasuda Yosuke, Fujiwara Ryo, Oguchi Tomohiko, Komai Yoshinobu, Numao Noboru, Yamamoto Shinya, Oki Ryosuke, Urasaki Tetsuya, Takahashi Shunji, Yonese Junji, Yuasa Takeshi
机构信息
Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
出版信息
Cancer Diagn Progn. 2023 May 3;3(3):327-333. doi: 10.21873/cdp.10219. eCollection 2023 May-Jun.
BACKGROUND/AIM: Immune-related adverse events (irAEs) develop in a subset of patients with metastatic renal cell carcinoma (mRCC) treated with immune-checkpoint-inhibitors (ICIs). Evidence regarding the prognostic impact of irAEs remains limited in these patients.
PATIENTS AND METHODS
Ninety-one consecutive patients with mRCC treated with ICIs were retrospectively analyzed. Overall survival (OS) rates were estimated using the Kaplan-Meier method. In multivariate analysis, predictors of OS were analyzed using the Cox-proportional-hazards-model.
RESULTS
Twenty-nine patients were treated with the combination of nivolumab plus ipilimumab. According to International Metastatic RCC Database Consortium risk classification, 27/47/17 patients were classified into favorable/intermediate/poor risk categories. The 1, 3, and 5-year OS-rates were 89, 70, and 57%, respectively. A total of 67 irAEs occurred in 44 patients (48%), including 15 patients with grade 3-4. OS was significantly longer in patients with irAEs (p=0.01). In multivariate analysis, Karnofsky performance status, prior nephrectomy, and irAEs were independent significant predictors of OS.
CONCLUSION
In our study, irAEs were significantly associated with OS in mRCC patients treated with ICIs.
背景/目的：接受免疫检查点抑制剂（ICI）治疗的转移性肾细胞癌（mRCC）患者中，一部分会发生免疫相关不良事件（irAE）。关于irAE对这些患者预后影响的证据仍然有限。
患者与方法
回顾性分析了91例连续接受ICI治疗的mRCC患者。采用Kaplan-Meier法估计总生存率（OS）。在多变量分析中，使用Cox比例风险模型分析OS的预测因素。
结果
29例患者接受纳武利尤单抗联合伊匹木单抗治疗。根据国际转移性RCC数据库联盟风险分类，27/47/17例患者被分为低/中/高风险类别。1年、3年和5年OS率分别为89%、70%和57%。44例患者（48%）共发生67次irAE，其中15例为3-4级。发生irAE的患者OS明显更长（p=0.01）。在多变量分析中，卡氏功能状态、既往肾切除术和irAE是OS的独立显著预测因素。
结论
在我们的研究中，irAE与接受ICI治疗的mRCC患者的OS显著相关。
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