Hu Qingjiang, Kudo Kensuke, Yukaya Takafumi, Hasuda Hirofumi, Nakanishi Ryota, Nakanoko Tomonori, Ando Koji, Ota Mitsuhiko, Kimura Yasue, Koga Tadashi, Kusumoto Tetsuya, Oki Eiji, Yoshizumi Tomoharu
Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan,
Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan.
Oncology. 2025;103(3):192-200. doi: 10.1159/000540840. Epub 2024 Sep 12.
This study aimed to evaluate the clinical impact of skeletal muscle mass and nutritional status in gastric cancer patients treated with nivolumab monotherapy as late-line treatment.
We conducted a multi-institutional retrospective study of 90 gastric cancer patients who previously received anti-PD-1 therapy (nivolumab). On computed tomography images captured before nivolumab induction, the skeletal muscle index (SMI, cm2/m2) was defined as the erector muscle area (cm2) divided by the height (m) squared. Patients were divided into two groups: those with SMI-high (n = 45) and those with SMI-low (n = 45). Prognostic nutritional index (PNI) was also calculated before nivolumab induction. The associations of SMI and PNI with response rate (RR), progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and safety were analyzed.
The cutoff values for SMI were determined as 13.45 for males and 10.41 for females. SMI-high was significantly associated with a higher RR (odds ratio = 12.36, p = 0.02) and DCR (odds ratio = 2.97, p = 0.02). Although not significant, PNI-high also tended to be associated with a higher RR. Multivariate analysis showed that SMI-high was independently associated with a higher RR and higher DCR in gastric cancer. Moreover, prognostic analyses revealed that SMI-high (log-rank test p = 0.008) and PNI-high (log-rank test p = 0.0008) were significantly associated with longer OS since nivolumab induction. SMI-high was also associated with longer PFS (log-rank test p = 0.03). There were no significant differences in immune-related adverse event between SMI-low and SMI-high.
SMI and PNI were associated with nivolumab efficacy in gastric cancer patients. Management of skeletal muscle loss and nutritional status in gastric cancer patients who will receive nivolumab would be beneficial to enhance survival outcomes.
本研究旨在评估接受纳武利尤单抗单药治疗作为晚期治疗的胃癌患者骨骼肌质量和营养状况的临床影响。
我们对90例先前接受抗PD-1治疗（纳武利尤单抗）的胃癌患者进行了多机构回顾性研究。在纳武利尤单抗诱导治疗前采集的计算机断层扫描图像上，骨骼肌指数（SMI，cm²/m²）定义为竖脊肌面积（cm²）除以身高（m）的平方。患者分为两组：SMI高组（n = 45）和SMI低组（n = 45）。在纳武利尤单抗诱导治疗前还计算了预后营养指数（PNI）。分析了SMI和PNI与缓解率（RR）、无进展生存期（PFS）、总生存期（OS）、疾病控制率（DCR）和安全性的相关性。
男性SMI的临界值确定为13.45，女性为10.41。SMI高与较高的RR（优势比 = 12.36，p = 0.02）和DCR（优势比 = 2.97，p = 0.02）显著相关。虽然不显著，但PNI高也倾向于与较高的RR相关。多变量分析显示，SMI高在胃癌中与较高的RR和较高的DCR独立相关。此外，预后分析显示，自纳武利尤单抗诱导治疗以来，SMI高（对数秩检验p = 0.008）和PNI高（对数秩检验p = 0.0008）与更长的OS显著相关。SMI高也与更长的PFS相关（对数秩检验p = 0.03）。SMI低组和SMI高组之间免疫相关不良事件无显著差异。
SMI和PNI与胃癌患者的纳武利尤单抗疗效相关。对接受纳武利尤单抗治疗的胃癌患者进行骨骼肌丢失和营养状况的管理将有利于提高生存结局。
