Low Geriatric Nutritional Risk Index as a Poor Prognostic Marker for Second-Line Pembrolizumab Treatment in Patients with Metastatic Urothelial Carcinoma: A Retrospective Multicenter Analysis
Low Geriatric Nutritional Risk Index as a Poor Prognostic Marker for Second-Line Pembrolizumab Treatment in Patients with Metastatic Urothelial Carcinoma: A Retrospective Multicenter Analysis
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DOI：
10.1159/000508923
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发表时间：
2020-11-01
期刊：
影响因子：
3.5
通讯作者：
Yasui, Takahiro
中科院分区：
文献类型：
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作者：
Etani, Toshiki;Naiki, Taku;Yasui, Takahiro
背景：我们评估了老年营养风险指数（GNRI）在二线派姆单抗（PEM）治疗转移性尿路上皮癌（mUC）患者中的预后效果。患者和方法：2018年1月至2019年10月，52名mUC患者接受了二线PEM治疗，此前接受过铂类化疗。在治疗开始时测量外周血参数：血清中性粒细胞与淋巴细胞比值（NLR）、血清白蛋白、血清c反应蛋白（CRP）、身高和体重。PEM静脉给予（每3周200毫克）。根据患者GNRI（= 92[高GNRI]）分为两组，回顾性分析资料。对所有患者的不良事件（ae）进行评估并进行影像学检查。用Kaplan-Meier曲线分析生存率和复发率。通过单因素和多因素Cox回归分析评估影响癌症特异性生存（CSS）的潜在预后因素。结果：两组患者的基线特征，除BMI和客观有效率外，无显著差异。高gnri组PEM治疗的中位总周期数明显更高（n[范围]:6[2-20]对3[1-6]）。在低gnri组和高gnri组，二线PEM治疗的中位CSS分别为3.6个月（95%可信区间[CI]: 2.5-6.1）和11.8个月（95% CI: 6.2-NA） （p < 0.01）。低、高crp组和- nrl组的CSS无显著差异。多因素Cox比例风险回归分析显示，较差的东部肿瘤合作组表现、内脏转移和较低的GNRI是短CSS的重要预后因素（95% CI: 1.62-6.10, HR: 3.14; 95% CI: 1.13-8.11, HR: 3.03; 95% CI: 1.32-8.02, HR: 3.25）。在ae中，低gnri组的疲劳发生率明显更高。结论：对于接受二线PEM治疗的mUC患者，GNRI是一个有用的预测生存结果的生物标志物。
Background: We evaluated the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in second-line pembrolizumab (PEM) therapy for patients with metastatic urothelial carcinoma (mUC). Patients and Methods: From January 2018 to October 2019, 52 mUC patients, treated previously with platinum-based chemotherapy, underwent second-line PEM therapy. Peripheral blood parameters were measured at the start of treatment: serum neutrophil-to-lymphocyte ratio (NLR), serum albumin, serum C-reactive protein (CRP), and body height and weight. PEM was intravenously administered (200 mg every 3 weeks). The patients were organized into two groups based on their GNRI (= 92 [high GNRI]), and the data were retrospectively analyzed. Adverse events (AEs) were evaluated and imaging studies assessed for all patients. Analyses of survival and recurrence were performed using Kaplan-Meier curves. Potential prognostic factors affecting cancer-specific survival (CSS) were assessed by univariate and multivariate Cox regression analyses. Results: patients' baseline characteristics, except for their BMI and objective response rate, did not significantly differ between the two groups. The median total number of cycles of PEM therapy was significantly higher for the high-GNRI group (n [range]: 6 [2-20] vs. 3 [1-6]). The median CSS with second-line PEM therapy was 3.6 months (95% confidence interval [CI]: 2.5-6.1) and 11.8 months (95% CI: 6.2-NA) in the low-GNRI and the high-GNRI group (p < 0.01), respectively. Significant differences in CSS between the low- and high-CRP or -NRL groups were not found. Multivariate Cox proportional-hazards regression analysis revealed that a poor Eastern Cooperative Oncology Group performance status, visceral metastasis, and a low GNRI were significant prognostic factors for short CSS (95% CI: 1.62-6.10, HR: 3.14; 95% CI: 1.13-8.11, HR: 3.03; 95% CI: 1.32-8.02, HR: 3.25, respectively). Of the AEs, fatigue showed a significantly higher incidence in the low-GNRI group. Conclusions: For mUC patients receiving second-line PEM therapy, the GNRI is a useful predictive biomarker for survival outcome.