Prognostic significance of cachexia in advanced non-small cell lung cancer patients treated with pembrolizumab
Prognostic significance of cachexia in advanced non-small cell lung cancer patients treated with pembrolizumab
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DOI：
10.1007/s00262-021-02997-2
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发表时间：
2021-06-27
影响因子：
5.8
通讯作者：
Ohe, Yuichiro
中科院分区：
文献类型：
--
作者：
Jo, Hitomi;Yoshida, Tatsuya;Ohe, Yuichiro
背景：癌症恶病质是一种多因素综合征，其特征为体重减轻，进而导致免疫功能障碍，常见于晚期非小细胞肺癌（NSCLC）患者。我们研究了恶病质对接受帕博利珠单抗治疗的晚期NSCLC患者预后的影响，并评估癌症恶病质的发病机制是否会影响临床结局。
患者与方法：本研究回顾性纳入了连续接受帕博利珠单抗治疗的晚期NSCLC患者。分析了与癌症恶病质发病机制相关的促炎细胞因子和食欲相关激素的血清水平。癌症恶病质的定义为：（1）过去6个月内体重减轻>5%；或（2）体重指数<20 kg/m²的患者体重减轻>2%。
结果：共纳入133例患者。恶病质患者占35.3%。恶病质组与非恶病质组的客观缓解率无显著差异（29.8% 对 34.9%，P = 0.550），但恶病质组的中位无进展生存期（PFS）和总生存期（OS）显著短于非恶病质组（PFS：4.2个月对7.1个月，P = 0.04；OS：10.0个月对26.6个月，P = 0.03）。血清肿瘤坏死因子-α（TNF-α）、白细胞介素-1α（IL-1α）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）和瘦素水平与恶病质的存在显著相关，但与PFS或OS无关。
结论：恶病质的存在与接受帕博利珠单抗治疗的晚期NSCLC患者预后不良显著相关，但与对帕博利珠单抗的反应无关。
Background Cancer cachexia is a multifactorial syndrome characterized by weight loss leading to immune dysfunction that is commonly observed in patients with advanced non-small cell lung cancer (NSCLC). We examined the impact of cachexia on the prognosis of patients with advanced NSCLC receiving pembrolizumab and evaluated whether the pathogenesis of cancer cachexia affects the clinical outcome. Patients and methods Consecutive patients with advanced NSCLC treated with pembrolizumab were retrospectively enrolled in the study. Serum levels of pro-inflammatory cytokines and appetite-related hormones, which are related to the pathogenesis of cancer cachexia, were analyzed. Cancer cachexia was defined as (1) a body weight loss > 5% over the past 6 months, or (2) a body weight loss > 2% in patients with a body mass index < 20 kg/m(2). Results A total of 133 patients were enrolled. Patients with cachexia accounted for 35.3%. No significant difference in the objective response rate was seen between the cachexia and non-cachexia group (29.8% vs. 34.9%, P = 0.550), but the median progression-free survival (PFS) and overall survival (OS) periods were significantly shorter in the cachexia group than in the non-cachexia group (PFS: 4.2 months vs. 7.1 months, P = 0.04, and OS: 10.0 months vs. 26.6 months, P = 0.03). The serum TNF-alpha, IL-1 alpha, IL-8, IL-10, and leptin levels were significantly associated with the presence of cachexia, but not with the PFS or OS. Conclusion The presence of cachexia was significantly associated with poor prognosis in advanced NSCLC patients receiving pembrolizumab, not with the response to pembrolizumab.