Department of Dermatology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
Department of Dermatology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
Acad Radiol. 2023 Sep;30 Suppl 1:S257-S267. doi: 10.1016/j.acra.2023.05.007. Epub 2023 Jun 16.
Despite the impressive efficacy of immune checkpoint inhibitors (ICIs) in the treatment of metastatic melanoma, not all patients respond to therapy. In addition, ICI harbors the risk for serious adverse events (AEs), highlighting the need for novel biomarkers predicting treatment response and occurrence of AEs. Recently, the identification of enhanced response to ICI in obese patients has indicated that body composition might influence treatment efficacy. The aim of the current study is to assess radiologic measurements of body composition as biomarkers for treatment response and AEs to ICI in melanoma.
In the current work, we analyze adipose tissue abundance and density, as well as muscle mass via computed tomography scans in a retrospective cohort of 100 patients with non-resectable stage III/IV melanoma receiving first-line treatment with ICI in our department. From these, we investigate the impact of the subcutaneous adipose tissue gauge index (SATGI) and other parameters of body composition on treatment efficacy and occurrence of AEs.
Low SATGI was associated with prolonged progression-free survival (PFS) in univariate and multivariate analyses (hazard ratio 2.56 [95% CI 1.18-5.55], P = .02), as well as an enhanced objective response rate (50.0% vs 27.1%; P = .02). Further analysis with a random forest survival model highlighted a nonlinear relationship between SATGI and PFS with a clear separation into high- and low-risk cohorts separated by the median. Finally, a significant enrichment of cases with vitiligo, but no other AEs, was observed in the SATGI-low cohort (11.5% vs 0%; P = .03).
We identify SATGI as a biomarker predicting treatment response to ICI without increased risk for severe AEs in melanoma.
尽管免疫检查点抑制剂（ICIs）在治疗转移性黑色素瘤方面具有显著疗效，但并非所有患者均对治疗有反应。此外，ICI 存在发生严重不良事件（AE）的风险，这凸显了寻找新的生物标志物来预测治疗反应和 AE 发生的必要性。最近，肥胖患者对 ICI 反应增强的发现表明，机体成分可能会影响治疗效果。本研究旨在评估黑色素瘤患者应用 ICI 治疗时，影像学测量的机体成分作为预测治疗反应和 AE 的生物标志物。
本研究分析了在我们科室接受 ICI 一线治疗的 100 例不可切除的 III/IV 期黑色素瘤患者的 CT 扫描中脂肪组织丰度和密度以及肌肉质量，探讨了皮下脂肪组织指标（SATGI）和其他机体成分参数对治疗效果和 AE 发生的影响。
单因素和多因素分析显示，低 SATGI 与无进展生存期（PFS）延长相关（风险比 2.56 [95%CI 1.18-5.55]，P = .02），客观缓解率也更高（50.0%比 27.1%；P = .02）。随机森林生存模型的进一步分析强调了 SATGI 与 PFS 之间的非线性关系，中位值可明确区分高风险和低风险队列。最后，SATGI 低的患者中更常见白癜风，而其他 AE 则少见（11.5%比 0%；P = .03）。
本研究确定 SATGI 是预测 ICI 治疗反应的生物标志物，不会增加黑色素瘤患者发生严重 AE 的风险。
