Age-Based Disparities in Metastatic Melanoma Patients Treated in the Immune Checkpoint Inhibitors (ICI) Versus Non-ICI Era: A Population-Based Study.
Age-Based Disparities in Metastatic Melanoma Patients Treated in the Immune Checkpoint Inhibitors (ICI) Versus Non-ICI Era: A Population-Based Study.
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DOI：
10.3389/fimmu.2021.609728
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发表时间：
2021
影响因子：
7.3
通讯作者：
Liu J
中科院分区：
文献类型：
--
作者：
Safi M;Al-Azab M;Jin C;Trapani D;Baldi S;Adlat S;Wang A;Ahmad B;Al-Madani H;Shan X;Liu J
免疫检查点抑制剂（ICI）已经彻底改变了转移性黑色素瘤的治疗，但我们对各年龄组ICI活性的了解还不够。本研究根据ICI批准时间选择不同年龄组的晚期黑色素瘤患者。黑色素瘤患者在2004-2016年的监测、流行病学和最终结果（SEER）数据库项目中确定。结果显示，在ICI出现之前（称为“非ICI时代”）有4，040例晚期黑色素瘤患者，而在ICI批准之后（称为“ICI时代”）有6，188例。在所有年龄组中，病例以男性为主。第一年龄组（20-59岁）和第二年龄组（60-74岁）在手术表现和持有保险单方面存在显著差异（p = 0.05）。第一和第二组（分别为20-59岁和60-70岁）的患者在生存率方面没有差异（中位数= 8个月），但在ICI时代的第一，第二和第三年龄组中差异明显，年轻组（20-59岁）具有显著更好的生存期（中位数分别为18、14和10个月，p = 0.0001）。对ICI时代第一组（最年轻）患者的多变量分析显示，与未接受手术的患者相比，手术与患者生存率的增加显著相关（p < 0.0001）。此外，在ICI时代所有年龄组中拥有保险政策与第一（20-59岁）和第二（60-74岁）年龄组的良好生存率相关（p = 0.0001），而在老年ICI组（>74岁）中没有生存差异。尽管ICI时代和非ICI时代的生存率存在差异，但这些结果表明ICI对晚期黑色素瘤年轻患者（第一年龄组）的生存率有积极影响，而对老年患者有有益影响。此外，做过癌症手术和持有保险单是患者生存的积极预测因素。这项研究强调，充分的临床和临床前研究对于提高各年龄组的ICI结局非常重要。
Immune checkpoint inhibitors (ICIs) have revolutionized metastatic melanoma treatment, but our knowledge of ICI activity across age groups is insufficient. Patients in different age groups with advanced melanoma were selected based on the ICI approval time in this study. Patients with melanoma were identified in the Surveillance, Epidemiology, and End Result (SEER) database program 2004–2016. The results showed that 4,040 patients had advanced melanoma before the advent of ICI (referred to as the “non-ICI era”), whereas there were 6,188 cases after ICI approval (referred to as the “ICI era”). In all age groups, the cases were dominated by men. The differences between the first (20–59 years) and second (60–74 years) age groups in both eras were significant in terms of surgery performance and holding of insurance policies (p = 0.05). The first and second groups (20–59 and 60–70 years old, respectively) showed no difference in survival (median = 8 months) during the non-ICI era, but the difference was evident in the first, second, and third age groups in the ICI era, with the younger group (20–59 years) having significantly better survival (median = 18, 14, and 10 months, respectively, p = 0.0001). Multivariate analysis of the first group (the youngest) in the ICI era revealed that surgery was significantly associated with an increase in survival among patients compared with those who did not undergo surgery (p < 0.0001). Furthermore, having an insurance policy among all age groups in the ICI era was associated with favorable survival in the first (20–59 years) and second (60–74 years) age groups (p = 0.0001), while there were no survival differences in the older ICI group (>74 years). Although there were differences in survival between the ICI era and the non-ICI era, these results demonstrate that ICI positively affected the survival of younger patients with advanced melanoma (first age group) than it had beneficial effects on older patients. Moreover, having had cancer surgery and holding an insurance policy were positive predictors for patient survival. This study emphasizes that adequate clinical and preclinical studies are important to enhance ICI outcomes across age groups.
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DOI：
10.1056/nejmoa1003466
发表时间：
2010-08-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Hodi FS;O'Day SJ;McDermott DF;Weber RW;Sosman JA;Haanen JB;Gonzalez R;Robert C;Schadendorf D;Hassel JC;Akerley W;van den Eertwegh AJ;Lutzky J;Lorigan P;Vaubel JM;Linette GP;Hogg D;Ottensmeier CH;Lebbé C;Peschel C;Quirt I;Clark JI;Wolchok JD;Weber JS;Tian J;Yellin MJ;Nichol GM;Hoos A;Urba WJ
通讯作者：
Urba WJ
影响因子：
5.2
作者：
Blankenstein, Stephanie A.;Aarts, Maureen J. B.;van Akkooi, Alexander C. J.
通讯作者：
van Akkooi, Alexander C. J.
影响因子：
8.4
作者：
Bastholt, Lars;Schmidt, Henrik;Svane, Inge Marie
通讯作者：
Svane, Inge Marie
影响因子：
20.4
作者：
Lichtenstein, Morgan R. L.;Nipp, Ryan D.;Gainor, Justin F.
通讯作者：
Gainor, Justin F.
影响因子：
4.6
作者：
Eaton, SC
通讯作者：
Eaton, SC