使用CT衍生的脂肪成分参数解释癌症患者免疫治疗中的肥胖悖论：一项系统评价和荟萃分析。
Explanation of the obesity paradox of immunotherapy in cancer patients using CT-derived adipose composition parameters: A systematic review and meta-analysis.
作者信息
Lou Jie, Guo Yusheng, Li Lingli, Yang Yanjie, Liu Chanyuan, Zheng Chuansheng, Yang Lian
机构信息
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China.
出版信息
Int Immunopharmacol. 2025 Jan 10;144:113699. doi: 10.1016/j.intimp.2024.113699. Epub 2024 Nov 30.
BACKGROUND
Although recent studies have reported that obesity is a protective factor for survival in patients with advanced cancers treated with immune checkpoint inhibitors (ICIs), the prognostic value of CT-derived adipose composition parameters remains unclear. This study aimed to assess the association between CT-derived adipose composition parameters and clinical outcomes in cancer patients undergoing ICIs treatment.
METHODS
A comprehensive search was conducted until May 2024 across several databases to gather relevant studies, including PubMed, Embase, Web of Science and Cochrane Library. Hazard ratios (HR) or odds ratios (OR) were used to assess the correlation between adiposity composition and clinical outcomes. The primary outcomes were overall survival (OS) and progression-free survival (PFS). The secondary outcomes were immune-related adverse events (irAEs).
RESULTS
A total of 2118 patients in 17 studies were included in the meta-analysis. Systemic analysis of all collected evidence revealed that high subcutaneous fat area (SFA) (OS: HR = 0.61, 95 % CI = 0.46-0.81, P < 0.001; PFS: HR = 0.65, 95 % CI = 0.50-0.85, P = 0.001) and high visceral fat index (VFI) (OS: HR = 0.68, 95 % CI = 0.56-0.83, P < 0.001; PFS: HR = 0.79, 95 % CI = 0.67-0.92, P = 0.003) were significantly associated with OS and PFS in cancer patients treated with ICIs. High subcutaneous fat index (SFI) was associated with better OS (HR = 0.64, 95 % CI = 0.48-0.86, P = 0.003) but not PFS (HR = 0.78, 95 % CI = 0.59-1.03, P = 0.083). However, no significant correlation was found between inter-muscular fat index (IFI) (OS: HR = 0.94, 95 % CI = 0.56-1.60, P = 0.833; PFS: HR = 1.00, 95 % CI = 0.62-1.62, P = 0.998) and OS or PFS in cancer patients under ICIs treatment.
CONCLUSION
CT-derived adipose composition parameters such as SFA, SFI and VFI are predictive of clinical outcomes in cancer patients treated with ICIs. Prospective cohorts with larger samples are needed to validate this hypothesis-generating data in the future.
背景
尽管最近的研究报告称，肥胖是接受免疫检查点抑制剂（ICI）治疗的晚期癌症患者生存的保护因素，但CT衍生的脂肪成分参数的预后价值仍不清楚。本研究旨在评估CT衍生的脂肪成分参数与接受ICI治疗的癌症患者临床结局之间的关联。
方法
截至2024年5月，在多个数据库（包括PubMed、Embase、科学网和考克兰图书馆）中进行了全面检索，以收集相关研究。采用风险比（HR）或优势比（OR）来评估肥胖成分与临床结局之间的相关性。主要结局为总生存期（OS）和无进展生存期（PFS）。次要结局为免疫相关不良事件（irAE）。
结果
荟萃分析共纳入了17项研究中的2118例患者。对所有收集到的证据进行系统分析后发现，高皮下脂肪面积（SFA）（OS：HR = 0.61，95%CI = 0.46 - 0.81，P < 0.001；PFS：HR = 0.65，95%CI = 0.50 - 0.85，P = 0.001）和高内脏脂肪指数（VFI）（OS：HR = 0.68，95%CI = 0.56 - 0.83，P < 0.001；PFS：HR = 0.79，95%CI = 0.67 - 0.92，P = 0.003）与接受ICI治疗的癌症患者的OS和PFS显著相关。高皮下脂肪指数（SFI）与更好的OS相关（HR = 0.64，95%CI = 0.48 - 0.86，P = 0.003），但与PFS无关（HR = 0.78，95%CI = 0.59 - 1.03，P = 0.083）。然而，在接受ICI治疗的癌症患者中，肌间脂肪指数（IFI）（OS：HR = 0.94，95%CI = 0.56 - 1.60，P = 0.833；PFS：HR = 1.00，95%CI = 0.62 - 1.62，P = 0.998）与OS或PFS之间未发现显著相关性。
结论
CT衍生的脂肪成分参数如SFA、SFI和VFI可预测接受ICI治疗的癌症患者的临床结局。未来需要更大样本量的前瞻性队列研究来验证这些产生假设的数据。
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