Diagnostic Comparison of CT Scans and Colonoscopy for Immune-Related Colitis in Ipilimumab-Treated Advanced Melanoma Patients
Diagnostic Comparison of CT Scans and Colonoscopy for Immune-Related Colitis in Ipilimumab-Treated Advanced Melanoma Patients
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DOI：
10.1158/2326-6066.cir-16-0302
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发表时间：
2017-04-01
影响因子：
10.1
通讯作者：
Ott, Patrick A.
中科院分区：
文献类型：
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作者：
Garcia-Neuer, Marlene;Marmarelis, Melina E.;Ott, Patrick A.
对于接受免疫检查点阻断抗体治疗的患者来说，结肠炎可能是一种危及生命的毒性。随着这些试剂的广泛使用，及时准确地诊断免疫性结肠炎变得越来越重要。为了更好地了解ipilimumab所致结肠炎的临床表现，并评估腹部/盆腔CT扫描作为诊断工具的使用，我们回顾分析了在我们机构接受ipilimumab治疗的晚期黑色素瘤患者。在303名患者中，99名(33%)在治疗过程中出现腹泻，46名患者(15%)接受了皮质类固醇治疗结肠炎。在腹泻患者中，48例(48%)接受了结肠镜检查，46例(46%)同时接受了CT和结肠镜检查。在34例(34%)接受CT和活检的患者中，CT对活检的结肠炎有很高的预测价值(阳性预测值为96%)，而CT表现的缺失对阴性活检的预测(阴性似然比为0.2)。在有症状和CT评估的患者中，CT高度预测需要激素才能达到症状的缓解(阳性预测值92%，阳性似然比7.3)。我们的结论是，CT是诊断结肠炎的一种快速、可靠和非侵入性的模式，而结肠镜检查和活检可能不需要确定诊断。(C)2017年AACR。
Colitis can be a life-threatening toxicity for patients treated with immune checkpoint blockade antibodies. With the anticipated widespread use of these reagents, the timely and accurate diagnosis of immune-related colitis becomes increasingly important. To better understand the clinical presentation of colitis from ipilimumab and to assess the use of CT scans of the abdomen/pelvis as a diagnostic tool, we retrospectively analyzed patients with advanced melanoma who received ipilimumab at our institution. Ninety nine (33%) of 303 patients developed diarrhea during therapy, and 46 patients (15%) received corticosteroids for colitis. Of the patients with diarrhea, 48 (48%) underwent colonoscopy and 46 (46%) underwent both CT and colonoscopy. In the 34 patients (34%) with a CT and biopsy, CT was highly predictive of colitis on biopsy (positive predictive value 96%), and the absence of CT findings was predictive of a negative biopsy (negative likelihood ratio 0.2). In patients who had symptoms and CT evaluation, CT was highly predictive of the need for steroids to reach resolution of symptoms (positive predictive value 92%, positive likelihood ratio 7.3). We conclude that CT is a fast, reliable, and noninvasive mode of diagnosing colitis, whereas colonoscopy and biopsy may not be needed to establish that diagnosis. (C) 2017 AACR.