Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
Immune checkpoint inhibitor-related colitis assessment and prognosis: can IBD scoring point the way?
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DOI：
10.1038/s41416-020-0882-y
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发表时间：
2020-05-18
影响因子：
8.8
通讯作者：
Brain, Oliver
中科院分区：
文献类型：
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作者：
Cheung, Vincent Ting Fung;Gupta, Tarun;Brain, Oliver
免疫检查点抑制剂（ICI）可改善生存率，但会导致免疫相关不良事件（irAE）。我们试图确定CTCAE分类、IBD生物标志物/内镜/组织学评分是否与irAE结肠炎结局相关。方法对2012年至2018年因黑色素瘤、非小细胞肺癌或尿路上皮癌接受ICI治疗的患者进行双中心回顾性研究。分析了人口统计学、临床数据、内镜检查（使用马约/溃疡性结肠炎内镜严重程度指数（UCEIS）评分重新分析）、组织学（使用Nancy指数评分）和治疗结局。结果共分析1074例患者。百分之十二（134）发展为irAE结肠炎。患者中位年龄为66岁，59%为男性。CTCAE腹泻分级与类固醇/英夫利西单抗使用无关。G3/4结肠炎患者更可能需要英夫利西单抗（p < 0.0001），但结肠炎分级与类固醇持续时间无关。C反应蛋白、白蛋白和血红蛋白与严重程度无关。UCEIS（p = 0.008）和马约（p = 0.016）评分与严重程度/英夫利西单抗需求相关。Nancy指数较高的患者（3/4）更可能需要英夫利西单抗（p = 0.03）。结论CTCAE评估不能准确反映结肠炎的严重程度，我们的数据不支持单独使用CTCAE，因为这可能对及时管理产生负面影响。我们的数据支持对CTCAE> 1级的患者使用内镜评分，并证明客观组织学评分的潜在预后效用。
Background Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes. Methods A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed. Results In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03). Conclusions CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.