Thyroid Dysfunction in Lung Cancer Patients Treated with Immune Checkpoint Inhibitors (ICIs): Outcomes in a Multiethnic Urban Cohort.
Thyroid Dysfunction in Lung Cancer Patients Treated with Immune Checkpoint Inhibitors (ICIs): Outcomes in a Multiethnic Urban Cohort.
复制标题
接受免疫检查点抑制剂(ICIS)治疗的肺癌患者的甲状腺功能障碍：多种族城市队列的结果。
DOI：
10.3390/cancers13061464
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发表时间：
2021-03-23
期刊：
影响因子：
5.2
通讯作者：
Halmos B
中科院分区：
文献类型：
--
作者：
D'Aiello A;Lin J;Gucalp R;Tabatabaie V;Cheng H;Bloomgarden NA;Tomer Y;Halmos B
哪些因素易使个体发生免疫相关不良事件（irAE）仍不清楚。此外，irAE与生存结局之间的关系需要进一步研究。我们试图在接受免疫检查点抑制剂（ICI）的肺癌患者的多样化城市队列中调查免疫治疗相关的甲状腺功能障碍与人口统计学和临床特征之间的关联。本研究旨在帮助识别irAE风险较高的患者，并阐明irAE是否预示着生存优势。我们试图在一个多种族的接受ICI治疗的肺癌患者队列中描述甲状腺功能障碍及其与基线临床和人口统计学特征以及无进展生存期（PFS）的相关性。对接受抗PD 1或PD-L1药物治疗的肺癌患者进行了回顾性病历审查。拟合多变量考克斯比例风险，以比较控制年龄、性别、治疗类型和持续时间的人种亚组之间至甲状腺功能障碍的时间。甲状腺功能障碍基于实验室检查;不需要临床症状。使用对数秩检验比较有和无甲状腺功能障碍患者在24周标志性分析点的PFS。我们确定了205例接受ICI的受试者，其中76例（37.1%）发生甲状腺功能障碍。一年内甲状腺功能障碍的发生率在所有种族中的发生率相似（p = 0.92）。性别和同期化疗与甲状腺功能不全无显著相关性（分别为p = 0.81和p = 0.67）。当采用对数秩检验（p = 0.016）和多变量考克斯回归（白色受试者HR 0.48，p = 0.09，西班牙裔受试者HR 0.36，p = 0.01）时，黑人受试者（25，31.6%）中甲状腺毒症的发生率高于白色受试者（7，16.7%）和西班牙裔受试者（8，12.7%）。当应用对数秩检验时，有和无甲状腺功能障碍的受试者的PFS相似（p = 0.353）。在接受ICI的患者中，性别、同时接受化疗和PFS与甲状腺功能不全无关;然而，黑人是甲状腺毒症的风险因素。种族在irAE发生中的作用机制值得进一步研究。
Which factors predispose individuals to developing immune-related adverse events (irAEs) remains unclear. In addition, the relationship between irAEs and survival outcomes warrants further investigation. We sought to investigate the association between immunotherapy-related thyroid dysfunction and demographic and clinical characteristics in a diverse urban cohort of patients with lung cancer receiving immune checkpoint inhibitors (ICIs). This study was conducted with the aim of helping to identify patients at a higher risk of experiencing irAEs and clarify whether irAEs portend a survival advantage. We sought to characterize thyroid dysfunction and its association with baseline clinical and demographic characteristics, as well as progression-free survival (PFS), in a multiethnic cohort of lung cancer patients treated with ICIs. A retrospective chart review of lung cancer patients receiving an anti-PD1 or PD-L1 agent was performed. Multivariate Cox proportional hazards were fitted to compare time to thyroid dysfunction among race subgroups controlling for age, gender, treatment type, and duration. Thyroid dysfunction was based on laboratory testing; clinical symptoms were not required. PFS at a 24-week landmark analysis point among patients with and without thyroid dysfunction was compared using a log-rank test. We identified 205 subjects that received ICIs, including 76 (37.1%) who developed thyroid dysfunction. Rates of thyroid dysfunction by one year occurred at similar frequencies among all races (p = 0.92). Gender and concurrent chemotherapy showed no significant association with thyroid dysfunction (p = 0.81 and p = 0.67, respectively). Thyrotoxicosis occurred at higher rates in Black (25, 31.6%) subjects than in White (7, 16.7%) and Hispanic (8, 12.7%) subjects when employing the log-rank test (p = 0.016) and multivariate Cox regression (HR 0.48, p = 0.09 for White and HR 0.36, p = 0.01 for Hispanic compared to Black subjects). PFS was similar among subjects with and without thyroid dysfunction when applying the log-rank test (p = 0.353). Gender, concurrent treatment with chemotherapy, and PFS were not associated with thyroid dysfunction in patients receiving ICIs; however, Black race was a risk factor for thyrotoxicosis. The mechanisms underlying the role of race in the development of irAEs warrant further study.