Relationship between efficacy outcomes and weight gain during treatment of advanced, non-squamous, non-small-cell lung cancer patients
Relationship between efficacy outcomes and weight gain during treatment of advanced, non-squamous, non-small-cell lung cancer patients
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DOI：
10.1093/annonc/mdw211
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发表时间：
2016-08-01
影响因子：
50.5
通讯作者：
Bonomi, P. D.
中科院分区：
文献类型：
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作者：
Patel, J. D.;Pereira, J. R.;Bonomi, P. D.
使用来自三项III期试验的汇总数据，将体重增加与晚期非鳞状NSCLC患者的结局进行比较。18%的患者在开始铂类化疗后体重增加> 5%。该亚组显示体重增加与生存率改善呈正相关（P < 0.001）。治疗期间的体重增加可能是临床获益的早期指标。非故意体重减轻发生在晚期非小细胞肺癌（NSCLC）患者中，与生存率降低相关。一项回顾性分析分析了来自三项国际III期研究的数据，这些研究包括2301例接受铂类药物为基础的一线双联治疗（联合或不联合贝伐单抗和维持治疗）的晚期非鳞状NSCLC患者。按照每项研究的时间表记录给药前后的体重。使用对数秩检验和校正的考克斯模型评估体重增加与总生存期（OS）和无进展生存期（PFS）之间的关系。Logistic回归分析了基线协变量与基线后体重增加之间的关系，421例（18.3%）患者基线后体重增加> 5%。超过一半的体重增加队列在3周前表现出初始体重增加。体重增加> 5%与千分之一货币符号5%亚组（n = 1880）的中位OS分别为16.7个月和10.7个月（P < 0.001）。PFS分别为6.9和4.8个月（P < 0.001）。总体肿瘤缓解率（分别为50.8%和25.4%）和疾病控制率（肿瘤缓解或疾病稳定）（分别为91.5%和63.6%）的差异也具有显著性（P < 0.001）。考克斯模型显示，在调整基线因素后，> 5%亚组的生存期[风险比（HR）= 0.54，95%置信区间（CI）0.47-0.62; P < 0.001]长于千分之一货币符号5%亚组。对于PFS，发现了类似的显著结果（HR = 0.59，95%CI 0.52-0.67; P < 0.001）。未经调整的逻辑回归分析显示体重增加（> 5%与千分之一货币符号5%）与年龄和BMI之间存在显著相关性。治疗期间体重增加可能是临床获益的早期指标。如果在前瞻性研究中得到证实，监测体重变化可能提供有关NSCLC生存结局的重要信息，并可能为新的治疗策略提供思路。
Weight gain was compared with outcomes in patients with advanced non-squamous NSCLC using pooled data from three phase III trials. Weight gain of > 5% occurred after initiation of platinum-based chemotherapy in 18% of patients. This subgroup exhibited a positive correlation between weight gain and improved survival (P < 0.001). Weight gain during treatment may be an early indicator of clinical benefit.Unintentional weight loss occurs among advanced non-small-cell lung cancer (NSCLC) patients and is associated with worse survival. Small studies have suggested that weight gain during treatment is associated with superior survival.A retrospective analysis analyzed data from three international phase III studies comprising 2301 advanced, non-squamous NSCLC patients who received a platinum-based, first-line doublet, with or without bevacizumab and maintenance therapy. Body weight was recorded before and after treatment by each study's schedule. The relationship between weight gain and overall survival (OS) and progression-free survival (PFS) was assessed using log-rank test and adjusted Cox modeling. Logistic regression assessed the association between baseline covariates and post-baseline weight gain.Four hundred and twenty-one (18.3%) patients had > 5% weight gain after baseline. More than half of the weight gain cohort exhibited initial weight gain by 3 weeks. The median OS was 16.7 months versus 10.7 months for the > 5% versus a parts per thousand currency sign5% weight gain subgroup (n = 1880) (P < 0.001). PFS was 6.9 versus 4.8 months, respectively (P < 0.001). Differences in overall tumor response rate (50.8% versus 25.4%, respectively) and disease control rate (tumor response or stable disease) (91.5% versus 63.6%, respectively) were also significant (P < 0.001). The Cox modeling revealed the > 5% subgroup had longer survival [hazard ratio (HR) = 0.54, 95% confidence interval (CI) 0.47-0.62; P < 0.001] than the a parts per thousand currency sign5% subgroup after adjusting for baseline factors. Similar significant results were found for PFS (HR = 0.59, 95% CI 0.52-0.67; P < 0.001). Unadjusted logistic regression indicated a significant association between weight gain (> 5% versus a parts per thousand currency sign5%) and age, and BMI.Weight gain during treatment may be an early indicator of clinical benefit. If confirmed in prospective studies, monitoring weight change may provide important information regarding survival outcomes in NSCLC and may provide ideas for new therapeutic strategies.