Rapid and objective CT scan prognostic scoring identifies metastatic patients with long-term clinical benefit on anti-PD-1/-L1 therapy
Rapid and objective CT scan prognostic scoring identifies metastatic patients with long-term clinical benefit on anti-PD-1/-L1 therapy
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DOI：
10.1016/j.ejca.2016.05.031
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发表时间：
2016-09-01
影响因子：
8.4
通讯作者：
Postel-Vinay, Sophie
中科院分区：
文献类型：
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作者：
Dercle, Laurent;Ammari, Samy;Postel-Vinay, Sophie
背景：靶向程序性死亡受体-1（PD-1）及其配体PD-L1的药物在多种恶性肿瘤中显示出活性。考虑到其新的作用机制，传统的预后评分是否也适用于接受这些药物治疗的患者尚不清楚。我们调查了基线3点（pt）计算机断层扫描（CT）（PS3-CT）评分和7点预后（PS 7）评分是否允许识别抗PD-1/-L1治疗的长期存活者。材料和方法：我们回顾了251例连续患者，这些患者参加了2011年12月26日至2015年9月7日期间评估抗PD-1/-L1药物的I期试验。PS3-CT计算采用高肿瘤负荷（TB 1D-RECIST> 9 cm）、低骨骼肌指数（SMI < 53 cm（2）m（-2））和非肺内脏转移（NPVM）（各1例）。PS 7通过增加较低的体能状态、血清白蛋白降低、血清乳酸脱氢酶升高和两个以上的远处转移（各1例患者）计算。使用Kaplan-Meier和多变量考克斯分析检验每个参数对总生存期（OS）的影响。结果：与皇家Marsden医院、Barbot和美国癌症联合委员会评分相比，PS3-CT是OS的显著独立预测因子（风险比[HR] = 1.39 [95%置信区间{CI} = 1.07-1.81]，p = 0.01）。高TB（n = 78）、低SMI（n = 55）和NPVM（n = 146）与较差的生存率相关（p < 0.01）。高TB和低SMI是OS的独立预测因子（死亡HR分别为：2.00 [95%CI = 1.38-2.88]，p < 0.01和1.75 [95%CI = 1.15-2.66]，p < 0.01）。PS 7是OS的显著预测因子（HR = 1.40 [95%CI = 1.25-1.56]，p < 0.01）。结论：基于三个CT扫描参数的客观和快速风险评分允许识别抗PD-1/-L1治疗的OS延长的患者，独立于传统的临床生物学预后评分。(C)2016爱思唯尔有限公司版权所有
Background: Drugs targeting programmed death receptor-1 (PD-1) and its ligand PD-L1 have shown activity in multiple malignancies. Considering their novel mechanism of action, whether traditional prognostic scores also apply to patients treated with these drugs is unknown. We investigated whether a baseline 3-point (pt) computed tomography (CT) scan (PS3-CT) score and a 7-pt prognostic (PS7) score allowed identifying long-term survivors on anti-PD-1/-L1 therapy.Materials and methods: We reviewed 251 consecutive patients enrolled in phase I trials evaluating anti-PD-1/-L1 agents between 26th December 2011 and 7th September 2015. PS3-CT was calculated using high tumour burden (TB1D-RECIST > 9 cm), low skeletal muscle index (SMI < 53 cm(2) m(-2)) and non-pulmonary visceral metastases (NPVM) (1 pt each). PS7 was calculated by adding lower performance status, decreased serum albumin, increased serum lactate dehydrogenase and more than two distant metastases (1 pt each). Effect on overall survival (OS) of each parameter was tested using Kaplan-Meier and multivariable Cox analyses.Results: PS3-CT was a significant independent predictor of OS (hazard ratio [HR] = 1.39 [95% confidence interval {CI} = 1.07-1.81], p = 0.01) when compared to the Royal Marsden Hospital, Barbot and American Joint Committee on Cancer scores. High TB (n = 78), low SMI (n = 55) and NPVM (n = 146) were associated with poorer survival (p < 0.01). High TB and low SMI were independent predictors of OS (respective HR of death: 2.00 [95% CI = 1.38-2.88], p < 0.01 and 1.75 [95% CI = 1.15-2.66], p < 0.01). PS7 was a significant predictor of OS (HR = 1.40 [95% CI = 1.25-1.56], p < 0.01).Conclusion: Objective and rapid-risk scoring based on three CT scan parameters allows identifying patients with prolonged OS on anti-PD-1/-L1 therapy, independently from conventional clinical-biological prognostic scores. (C) 2016 Elsevier Ltd. All rights reserved.