转移性肾细胞癌患者接受一线免疫治疗时标准实验室参数的预后潜力。
Prognostic potential of standard laboratory parameters in patients with metastatic renal cell cancer receiving first-line immunotherapy.
机构信息
Department of Urology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
German Cancer Consortium (DKTK), Partner Site Dresden, Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
出版信息
Sci Rep. 2024 Oct 25;14(1):25365. doi: 10.1038/s41598-024-76928-3.
Through their involvement in cancer metabolism, alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), γ-glutamyltransferase (GGT) and lactate dehydrogenase (LDH) reflect the tumor burden and thus could have a prognostic potential for patients treated with immune checkpoint inhibitors (CPI). Therefore, this study investigated the prognostic potential of these parameters in a real-world cohort of patients with metastatic renal cell cancer (mRCC) under first-line CPI-based therapy. The retrospective study cohort included 82 mRCC patients treated with CPI-based first-line therapy between 2019 and 2023. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated according to baseline levels and early dynamic changes of ALAT, ASAT, GGT and LDH. Multivariate Cox proportional hazard regression models were generated to identify independent prognosticators for PFS and OS. High baseline levels and non-normalized kinetics of ALAT, ASAT, GGT and LDH were significantly associated with shorter PFS and OS (p < 0.05), which was also reflected by lower response rates. Combining the four parameters at baseline into a 4-Risk-Score resulted in an enhanced prognostic power, as indicated by a higher C-index of 0.693 for OS compared to the individual parameters (≤ 0.663). Patients with all four risk factors present showed the worst PFS and OS. Overall, baseline levels and early kinetics of the four parameters as well as the 4-Risk-Score were identified as independent prognosticators for PFS and OS by multivariate analysis. As standard laboratory parameters, ALAT, ASAT, GGT and LDH are cost-effective and could be easily used either alone or in combination for therapy monitoring of CPI-treated mRCC patients.
通过参与癌症代谢,丙氨酸氨基转移酶(ALAT)、天冬氨酸氨基转移酶(ASAT)、γ-谷氨酰转移酶(GGT)和乳酸脱氢酶(LDH)反映肿瘤负担,因此可能对接受免疫检查点抑制剂(CPI)治疗的患者具有预后潜力。因此,本研究调查了这些参数在接受一线基于 CPI 的治疗的转移性肾细胞癌(mRCC)患者真实队列中的预后潜力。回顾性研究队列包括 82 名接受 CPI 一线治疗的 mRCC 患者,治疗时间为 2019 年至 2023 年。根据基线水平和 ALAT、ASAT、GGT 和 LDH 的早期动态变化,评估无进展生存期(PFS)、总生存期(OS)和反应率。生成多变量 Cox 比例风险回归模型,以确定 PFS 和 OS 的独立预后因素。高基线水平和 ALAT、ASAT、GGT 和 LDH 的非正常动力学与较短的 PFS 和 OS 显著相关(p<0.05),这也反映了较低的反应率。将基线时的四个参数结合在一起形成 4 风险评分可提高预后能力,OS 的 C 指数为 0.693 高于单个参数(≤0.663)。四项风险因素均存在的患者的 PFS 和 OS 最差。总的来说,多变量分析确定基线水平和四个参数的早期动力学以及 4 风险评分是 PFS 和 OS 的独立预后因素。作为标准实验室参数,ALAT、ASAT、GGT 和 LDH 具有成本效益,可单独或联合用于监测接受 CPI 治疗的 mRCC 患者的治疗。
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