Association of Systemic Inflammation Index and Body Mass Index with Survival in Patients with Renal Cell Cancer Treated with Nivolumab
Association of Systemic Inflammation Index and Body Mass Index with Survival in Patients with Renal Cell Cancer Treated with Nivolumab
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DOI：
10.1158/1078-0432.ccr-18-3661
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发表时间：
2019-07-01
影响因子：
11.5
通讯作者：
Sternberg, Cora N.
中科院分区：
文献类型：
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作者：
De Giorgi, Ugo;Procopio, Giuseppe;Sternberg, Cora N.
目的：炎症指数和体重指数（BMI）很容易评估，预测生存率，并且可能是可修改的。我们评估了炎症指数和BMI与肾细胞癌（RCC）患者接受免疫检查点抑制剂therapeutic.Experimental Designs的临床结果的潜在关联：对2015年7月至2016年4月在意大利扩大使用计划中招募的接受纳武利尤单抗治疗的转移性RCC患者的前瞻性队列进行了检查。炎症的参考指标确定为嗜中性粒细胞-淋巴细胞比率（NLR）= 3，全身免疫炎症指数（SII）= 1，375，血小板-淋巴细胞比率（PLR）= 232。结果：在313例可评估的患者中，235例（75.1%）为男性，中位年龄为65岁（范围40-84岁），105例（33.69%）≥ 70岁。在单变量分析中，年龄、体能状态、BMI、SII、NLR和PLR能够预测结局。在多变量分析中，SII ≥ 1,375、BMI < 25 kg/m2和年龄≥ 70岁独立预测总生存率[OS; HR = 2.96，95%CI，2.05-4.27; HR = 1.59，95%CI，1.10-2.30; HR = 1.65，95%CI分别为1.07-2.55）。SII >= 1,375且BMI < 25 kg/m2的患者的OS估计比没有或只有一个危险因素的患者差得多（HR，3.37; 95% CI，2.29-4.95; P < 0.0001）。3个月时的SII变化预测OS（P < 0.0001）。结论：正常BMI与炎症相结合使死亡风险增加了两倍，表明这些生物标志物是用纳武单抗治疗的RCC患者中OS的关键预后因素。
Purpose: Inflammation indexes and body mass index (BMI) are easily evaluated, predict survival, and are potentially modifiable. We evaluated the potential association of inflammatory indexes and BMI with the clinical outcome of patients with renal cell carcinoma (RCC) undergoing immune checkpoint inhibitor therapy.Experimental Design: A prospective cohort of patients with metastatic RCC treated with nivolumab enrolled in the Italian Expanded Access Program from July 2015 through April 2016 was examined. Reference measures of inflammation were identified for neutrophil-to-lymphocyte ratio (NLR) = 3, systemic immune inflammation index (SII) = 1,375, and platelet-tolymphocyte ratio (PLR) = 232. Patients were classified as high BMI (>= 25 kg/m(2)) versus normal BMI (< 25 kg/m(2)).Results: Among 313 evaluable patients, 235 (75.1%) were male, and median age was 65 years (range, 40-84 years), with 105 (33.69%) >= 70 years. In univariate analysis, age, performance status, BMI, SII, NLR, and PLR were able to predict outcome. In multivariate analyses, SII >= 1,375, BMI < 25 kg/m(2), and age >= 70 years independently predicted overall survival [OS; HR = 2.96, 95% confidence interval (CI), 2.05-4.27; HR = 1.59, 95% CI, 1.10-2.30; and HR = 1.65, 95% CI, 1.07-2.55, respectively). A patient with both SII >= 1,375 and BMI < 25 kg/m(2) was estimated to have much worse OS (HR, 3.37; 95% CI, 2.29-4.95; P < 0.0001) than a patient with neither or only one risk factor. SII changes at 3 months predicted OS (P < 0.0001).Conclusions: Normal BMI combined with inflammation tripled the risk of death, suggesting that these biomarkers are critical prognostic factors for OS in patients with RCC treated with nivolumab.