Department of Clinical Oncology, Military Cancer Center, Royal Medical Services, Amman, Jordan.
Department of Internal Medicine, Military Cancer Center, Royal Medical Services, Amman, Jordan.
Rom J Intern Med. 2024 Mar 23;62(1):33-43. doi: 10.2478/rjim-2023-0025. Print 2024 Mar 1.
Hyperprogressive disease (HPD) can be described as an accelerated increase in the growth rate of tumors combined with rapid clinical deterioration observed in a subset of cancer patients undergoing immunotherapy, specifically with immune checkpoint inhibitors (ICIs). The reported incidence of HPD ranges from 5.9% to 43.1% in patients receiving ICIs. In this context, identifying reliable predictive risk factors for HPD is crucial as it may allow for earlier intervention and ultimately improve patient outcomes.
This study retrospectively analyzed ten metastatic renal cell carcinoma (mRCC) patients. The identification of HPD was based on the diagnostic criteria proposed by Ferrara R This study aimed to investigate whether there is an association between LN size and HPD using a cutoff value of 3 cm for LN size. Given the limited sample size, Fisher's exact test was used to test this association. We conducted a Kaplan-Meier (KM) analysis to estimate the median overall survival (OS) of patients with HPD and compared it to those without HPD.
Three patients (30%) developed HPD, while seven (70%) did not. Fisher's exact test revealed a statistically significant association between the HPD and LN size ≥ 3 cm (p=0.008). In the HPD group, the median OS was significantly shorter, with a median OS of 3 months, whereas in the non-HPD group, the median OS was not reached (P =0.001).
The present study found a significant association between LN size ≥ 3 cm in the pretreatment period and HPD development.
在接受免疫治疗的癌症患者中，尤其是免疫检查点抑制剂（ICI）治疗的患者中，有一部分患者出现了肿瘤生长速度加快并伴有快速临床恶化的情况，即超进展性疾病（HPD）。目前，接受 ICI 治疗的患者中 HPD 的发生率为 5.9%~43.1%。因此，确定 HPD 的可靠预测风险因素至关重要，这可能有助于早期干预，并最终改善患者的预后。
本研究回顾性分析了 10 例转移性肾细胞癌（mRCC）患者。HPD 的诊断标准基于 Ferrara R 等提出的标准。本研究旨在探讨 LN 大小与 HPD 是否存在相关性，将 LN 大小的截断值设定为 3cm。由于样本量有限，采用 Fisher 确切检验来检验这种相关性。我们进行了 Kaplan-Meier（KM）分析，以估计 HPD 患者的中位总生存期（OS），并与无 HPD 患者进行比较。
3 例（30%）患者发生 HPD，7 例（70%）患者未发生 HPD。Fisher 确切检验显示 HPD 与 LN 大小≥3cm 之间存在显著相关性（p=0.008）。在 HPD 组中，中位 OS 明显缩短，为 3 个月，而在无 HPD 组中，中位 OS 尚未达到（P=0.001）。
本研究发现，治疗前 LN 大小≥3cm 与 HPD 发生之间存在显著相关性。
