Yalçıner Merih, Yazgan Satı Coşkun, Mocan Eda Eylemer, Karaoğlan Beliz Bahar, Bölek Hatice, Yekedüz Emre, Ürün Yüksel
Medical Oncology Department, Faculty of Medicine, School of Medicine, Cebeci Hospital, Ankara University, Dikimevi, 06590, Ankara, Turkey.
Clin Transl Oncol. 2025 Jan 28. doi: 10.1007/s12094-025-03848-7.
Immunotherapy efficacy in elderly patients with comorbidities and poor performance status is not well understood. More knowledge on this topic is needed to identify subgroups that will benefit from immunotherapy. We aimed to evaluate the effect of comorbidity burden in patients receiving immunotherapy.
METHODS/PATIENTS: Patients older than 18 years of age and diagnosed with various malignancies, followed up in our tertiary cancer center were screened. Patients treated with immunotherapy were included in this study. We used to Charlson Comorbidity Index (CCI) to evaluate patients' comorbidity burden. The primary outcome was overall survival (OS). Hazard ratio (HR) with confidence interval (CI) was evaluated in multivariable analysis.
A total number of 197 patients were included. The median age was 62 years. Patients were grouped based on CCI scores: CCI-low (≤ 8) and CCI-high (> 8). One-hundred and seven patients (54.9%) had metastatic disease at the time of diagnosis. Most frequently used immunotherapy agent was nivolumab (n = 124, 62.9%), followed by pembrolizumab (n = 36, 18.3%). The median OS was shorter in the CCI-high group than in the CCI-low group (10.6 vs. 21.2 months, p = 0.002) In multivariable analysis, treatment with anti-CTLA4 (HR: 1.85, 95% CI 1.07-3.20, p = 0.028), ECOG performance status (2-4 vs. 0-1) (HR: 2.17; 95% CI 1.25-3.75; p = 0.005), and higher CCI scores (CCI-high vs. CCI-low) (HR: 1.97; 95% CI 1.3-3.0; p = 0.001) were independently associated with worse OS.
Comorbidity burden and performance status independently predict survival outcomes in immunotherapy-treated cancer patients. Comprehensive comorbidity assessment is essential for optimizing treatment and improving patient outcomes.
免疫疗法在合并症患者及体能状态较差的老年患者中的疗效尚不清楚。需要更多关于该主题的知识来确定能从免疫疗法中获益的亚组。我们旨在评估合并症负担对接受免疫疗法患者的影响。
方法/患者：对在我们的三级癌症中心接受随访、年龄大于18岁且被诊断患有各种恶性肿瘤的患者进行筛查。接受免疫疗法治疗的患者纳入本研究。我们使用查尔森合并症指数（CCI）来评估患者的合并症负担。主要结局是总生存期（OS）。在多变量分析中评估风险比（HR）及置信区间（CI）。
共纳入197例患者。中位年龄为62岁。患者根据CCI评分分组：低CCI组（≤8）和高CCI组（>8）。107例患者（54.9%）在诊断时患有转移性疾病。最常用的免疫疗法药物是纳武单抗（n = 124，62.9%），其次是帕博利珠单抗（n = 36，18.3%）。高CCI组的中位OS短于低CCI组（10.6个月对21.2个月，p = 0.002）。在多变量分析中，抗CTLA4治疗（HR：1.85，95%CI 1.07 - 3.20，p = 0.028）、东部肿瘤协作组（ECOG）体能状态（2 - 4对0 - 1）（HR：2.17；95%CI 1.25 - 3.75；p = 0.005）以及较高的CCI评分（高CCI组对低CCI组）（HR：1.97；95%CI 1.3 - 3.0；p = 0.001）与较差的OS独立相关。
合并症负担和体能状态独立预测接受免疫疗法治疗的癌症患者的生存结局。全面的合并症评估对于优化治疗和改善患者结局至关重要。
