Prognostic significance of autoimmunity during treatment of melanoma with interferon
Prognostic significance of autoimmunity during treatment of melanoma with interferon
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DOI：
10.1056/nejmoa053007
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发表时间：
2006-02-16
影响因子：
158.5
通讯作者：
Kirkwood, JM
中科院分区：
文献类型：
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作者：
Gogas, H;Ioannovich, J;Kirkwood, JM
背景：晚期黑色素瘤的免疫治疗会引起自身免疫的血清学和临床表现。我们评估了接受高剂量辅助干扰素 alfa-2b 治疗的 IIB、IIC 或 III 期黑色素瘤患者的自身免疫的预后意义。方法：我们招募了 200 名患者参加一项更大的、正在进行的随机试验的子研究。在开始静脉干扰素治疗前、治疗1个月后以及第3、6、9和12个月时采集血液。检测血清中的抗甲状腺、抗核、抗DNA和抗心磷脂自身抗体，并对患者进行白癜风检查。结果：中位随访时间为45.6个月。 115名患者出现复发，82名患者死亡。中位无复发生存期为 28.0 个月，中位总生存期为 58.7 个月。 52 名患者（26%）检测到自身抗体和自身免疫临床表现。无自身免疫性患者的中位无复发生存期为 16.0 个月（148 名患者中有 108 名复发），而有自身免疫性患者则未达到该水平（52 名患者中有 7 名复发）。无自身免疫性患者的中位生存期为 37.6 个月（148 名患者中的 80 名死亡），而患有自身免疫性患者的中位生存期未达到（52 名患者中的 2 名死亡）。在单变量和多变量回归分析中，自身免疫是改善无复发生存率和总生存率的独立预后标志物（P
BACKGROUND:Immunotherapy for advanced melanoma induces serologic and clinical manifestations of autoimmunity. We assessed the prognostic significance of autoimmunity in patients with stage IIB, IIC, or III melanoma who were treated with high-dose adjuvant interferon alfa-2b.METHODS:We enrolled 200 patients in a substudy of a larger, ongoing randomized trial. Blood was obtained before the initiation of intravenous interferon therapy, after 1 month of therapy, and at 3, 6, 9, and 12 months. Serum was tested for antithyroid, antinuclear, anti-DNA, and anticardiolipin autoantibodies, and patients were examined for vitiligo.RESULTS:The median duration of follow-up was 45.6 months. Relapse occurred in 115 patients, and 82 patients died. The median relapse-free survival was 28.0 months, and the median overall survival was 58.7 months. Autoantibodies and clinical manifestations of autoimmunity were detected in 52 patients (26 percent). The median relapse-free survival was 16.0 months among patients without autoimmunity (108 of 148 had a relapse) and was not reached among patients with autoimmunity (7 of 52 had a relapse). The median survival was 37.6 months among patients without autoimmunity (80 of 148 died) and was not reached among patients with autoimmunity (2 of 52 died). In univariate and multivariate regression analyses, autoimmunity was an independent prognostic marker for improved relapse-free survival and overall survival (P