Shibutani Yuma, Imaoka Takuro, Suzuki Atsuko, Tajiri Kazuko
Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan.
Cancer Diagn Progn. 2025 Sep 1;5(5):634-641. doi: 10.21873/cdp.10479. eCollection 2025 Sep-Oct.
BACKGROUND/AIM: Although immune checkpoint inhibitors (ICIs) have demonstrated high therapeutic efficacy against malignant tumors, immune-related cardiovascular adverse events remain a significant concern. While myocarditis is a well-recognized complication, mild troponin elevations without clinical symptoms have been increasingly observed. The prognostic significance of such subclinical elevations remains unclear. This study aimed to evaluate the relationship between asymptomatic troponin elevation and early mortality in patients receiving ICIs without cardiac adverse events.
This retrospective, single-center study included 108 patients who received ICIs and had high-sensitivity troponin T (hs-TnT) levels measured at baseline and after treatment initiation. Patients diagnosed with myocarditis or other overt cardiac events were excluded. The patients were categorized into two groups based on hs-TnT elevation after ICI therapy.
Among the 108 patients, 26 (24.1%) exhibited hs-TnT elevation post-ICI without developing myocarditis or other cardiac diseases. The peak hs-TnT levels were significantly higher in these patients compared to those without elevation [28 (IQR=18-38) ng/l 11 (8-13) ng/l, 0.001], though still mildly elevated. Over a median follow-up of 174 days, 24 patients died, all due to cancer progression. Notably, those who died within one month of peak hs-TnT had higher levels than those who died after 1-3 or >3 months.
Subclinical troponin elevation is common in patients treated with ICIs. Higher troponin levels may be associated with earlier death; however, the underlying mechanisms remain unclear. Careful interpretation is needed and further research is required to clarify its prognostic value.
背景/目的：尽管免疫检查点抑制剂（ICIs）已显示出对恶性肿瘤的高治疗效果，但免疫相关的心血管不良事件仍然是一个重大问题。虽然心肌炎是一种公认的并发症，但越来越多地观察到肌钙蛋白轻度升高而无临床症状的情况。这种亚临床升高的预后意义仍不清楚。本研究旨在评估在没有心脏不良事件的接受ICIs治疗的患者中，无症状肌钙蛋白升高与早期死亡率之间的关系。
这项回顾性单中心研究纳入了108例接受ICIs治疗且在基线和治疗开始后测量了高敏肌钙蛋白T（hs-TnT）水平的患者。诊断为心肌炎或其他明显心脏事件的患者被排除。根据ICI治疗后hs-TnT升高情况将患者分为两组。
在108例患者中，26例（24.1%）在ICI治疗后出现hs-TnT升高，但未发生心肌炎或其他心脏疾病。与未升高的患者相比，这些患者的hs-TnT峰值水平显著更高[28（四分位间距=18-38）ng/l对11（8-13）ng/l，P=0.001]，尽管仍为轻度升高。在中位随访174天期间，24例患者死亡，均死于癌症进展。值得注意的是，在hs-TnT峰值后1个月内死亡的患者的水平高于在1-3个月或>3个月后死亡的患者。
亚临床肌钙蛋白升高在接受ICIs治疗的患者中很常见。较高的肌钙蛋白水平可能与较早死亡有关；然而，潜在机制仍不清楚。需要谨慎解读，并且需要进一步研究以阐明其预后价值。
