Cachexia index in predicting outcomes among patients receiving immune checkpoint inhibitor treatment for metastatic renal cell carcinoma
Cachexia index in predicting outcomes among patients receiving immune checkpoint inhibitor treatment for metastatic renal cell carcinoma
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DOI：
10.1016/j.urolonc.2022.07.018
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发表时间：
2022-10-20
影响因子：
2.7
通讯作者：
Yazici, Ozan
中科院分区：
文献类型：
--
作者：
Aslan, Volkan;Kilic, Atiye Cenay Karabork;Yazici, Ozan
简介：免疫检查点抑制剂（ICI）改变了转移性肾细胞癌（mRCC）患者的治疗方法。尽管一些患者从ICI治疗中获益匪浅，但缺乏一种有效的标记物来确定哪些患者将从这些治疗中获益。此外，慢性炎症和肌肉减少症与癌症患者的生存率低有关。因此，在这项研究中，我们研究了恶病质指数（CXI），作为肌肉减少症和慢性炎症的综合评分，如何影响接受ICI的mRCC患者的生存结局。研究方法：我们回顾性筛选了52例mRCC患者的数据，这些患者在接受ICI作为二线或后续治疗后，于2010年10月至2021年10月期间进行了随访。根据L3椎体骨骼肌肉骨骼面积（SMI）、嗜中性淋巴细胞比率（NLR）和白蛋白（Alb）水平，根据以下公式计算患者各自的基础CXI评分：CXI =（SMI x Alb）/ NLR。此外，我们还分析了患者的皮下脂肪组织（SAT）、体重指数（BMI）、ECOG体能状态、国际转移性肾细胞癌数据库联盟（IMDC）风险评分、肾切除术状态、转移部位和组织学亚型如何影响生存结局。结果：我们的单变量分析显示CXI评分、NLR、肾切除状态和患者年龄与总生存期（OS）显著相关。然而，只有CXI评分的意义是通过多变量分析证实的。CXI评分<中位值的患者中位OS（mOS）为7个月，CXI评分&GE;中位值的患者中位OS为48个月。(HR 4.5，95% CI [1.9-11]，p = 0.001）。只有CXI与无进展生存期（PFS）结局显著相关。CXI评分<中位值的患者中位无进展生存期（mPFS）为4个月，CXI评分&GE;中位值的患者中位无进展生存期（mPFS）为17个月。(HR 2.6，95% CI [1.3，5.3]，p = 0.007）。肌肉减少症，肌肉减少性肥胖症，肌肉减少症与NLR没有发现显着影响OS。结论：我们的研究结果表明，CXI评分，肌肉减少症和慢性炎症参数的综合指标，可以作为一个有用的标志物，在预测ICI为基础的治疗mRCC患者的结果。(c)2022爱思唯尔公司All rights reserved.
Introduction: Immune checkpoint inhibitors (ICI) have transformed treatments for patients with metastatic renal cell carcinoma (mRCC). Although some patients benefit greatly from ICI treatments, an effective marker to determine which patients will benefit from these treatments is lacking. Moreover, chronic inflammation and sarcopenia have been associated with poor survival rates among cancer patients. Accordingly, in this study, we investigated how the cachexia index (CXI), used as a combined score for sarcopenia and chronic inflammation, affects the survival outcomes of patients with mRCC receiving ICI. Methods: We retrospectively screened data from 52 mRCC patients who had followed up between October 2010 and October 2021 after receiving ICI as a second-line or later treatment. Patients' respective basal CXI score were calculated according to the following formula, based on their L3 vertebral skeletal musculoskeletal area (SMI), neutrophil-lymphocyte ratio (NLR), and albumin (Alb) levels: CXI = (SMI x Alb) / NLR. Additionally, we analyzed how patients' subcutaneous adipose tissue (SAT), body mass index (BMI), ECOG performance status, The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score, nephrectomy status, sites of metastasis, and histological subtypes affected survival outcomes. Results: Our univariate analysis significantly associated CXI score, NLR, nephrectomy status, and patient age with overall survival (OS). However, only CXI scores' significance was confirmed through multivariate analysis. The median OS (mOS) was 7 months for patients whose CXI score < the median value and 48 months for patients with a CXI score & GE; the median value. (HR 4.5, 95% CI [1.9-11], p = 0.001). Only CXI was significantly associated with progression-free survival (PFS) outcomes. The median progression-free survival (mPFS) was 4 months for patients whose CXI score < the median value and 17 months for patients with a CXI score & GE; the median value. (HR 2.6, 95% CI [1.3, 5.3], p = 0.007). Sarcopenia, sarcopenic obesity, and sarcopenia combined with NLR were not found to significantly affect OS. Conclusion: Our findings suggest that CXI score, a combined indicator of sarcopenia and chronic inflammation parameters, may serve as a useful marker in predicting the outcomes of ICI-based treatments for mRCC patients. (c) 2022 Elsevier Inc. All rights reserved.