帕博利珠单抗治疗复发/转移性头颈部鳞状细胞癌患者的预后与营养因素的相关性分析  

Analysis of correlation between nutritional factors and prognosis in patients with recurrent/metastatic head and neck squamous cell carcinoma treated with pembrolizumab

作　　者：张心怡 林超 芮孟瑜 韩如雪 丁琦 任国欣[2] Xinyi Zhang;Chao Lin;Mengyu Rui;Ruxue Han;Qi Ding;Guoxin Ren(School of Stomatology,Weifang Medical University,Weifang 261000,China;Department of Oral Maxillofacial-Head and Neck Oncology,Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,National Clinical Research Center of Stomatology,Shanghai 200001,China)

机构地区：[1]潍坊医学院口腔医学院,山东省潍坊市261000 [2]上海交通大学医学院附属第九人民医院口腔颌面头颈肿瘤科,国家口腔疾病临床医学研究中心,上海市200001

出　　处：《中国肿瘤临床》2022年第17期892-896,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探究接受帕博利珠单抗二线治疗复发/转移性(recurrent/metastatic, R/M)头颈部鳞状细胞癌(head and neck squamous cell carcinoma,HNSCC)患者的临床相关营养因素与预后的相关性。方法:回顾性分析2019年1月至2021年6月上海交通大学医学院附属第九人民医院收治的86例接受帕博利珠单抗治疗的R/M HNSCC患者,对其进行生存预后分析和危险因素评估。结果:中位随访时间11.6(3.0~25.9)个月,中位总生存期(overall survival,OS)11.3个月,中位无进展生存期(progression-free survival,PFS)8.3个月。多因素分析显示,体质量不足(OS:P=0.016;PFS:P=0.003)、年龄≥60岁(OS:P=0.009;PFS:P=0.014)、低白蛋白(OS:P=0.013;PFS:P=0.010)、体力状态(PS)评分≥2分(OS:P<0.001;PFS:P=0.005)、联合阳性评分(CPS)<1(OS:P=0.009;PFS:P=0.006)及临床分期rⅣ期(OS:P=0.011;PFS:P=0.003)是死亡风险增加的独立风险因素。超重是减少死亡风险的指标(OS:P=0.001;PFS:P=0.004)。Kaplan-Meier生存曲线分析显示,BMI及血清白蛋白与OS及PFS显著相关(P<0.001)。结论:BMI、年龄、血清白蛋白、PS评分、CPS评分、临床分期与接受帕博利珠单抗治疗的R/M HNSCC患者预后显著相关,可作为R/M HNSCC患者抗PD-1治疗的独立预后预测指标。Objective:To investigate the correlation between clinically relevant nutritional indicators and prognosis in patients receiving pembrolizumab as second-line treatment for recurrent/metastatic head and neck squamous cell carcinoma(R/M HNSCC).Methods:This retrospective analysis of 86 patients with R/M HNSCC treated with pembrolizumab admitted to Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to June 2021 was performed for survival prognosis analysis and risk factor assessment.Results:The median follow-up,median overall survival(OS),median progression-free survival(PFS)were 11.6(3.0-25.9)months,11.3 months and 8.3 months,respectively.Multifactorial analysis showed that underweight(OS:P=0.016;PFS:P=0.003),age≥60 years(OS:P=0.009;PFS:P=0.014),lower serum albumin(OS:P=0.013;PFS:P=0.010),performance status(PS)scores≥2(OS:P<0.001;PFS:P=0.005),combined positive score(CPS)<1(OS:P=0.009,PFS:P=0.006)and rⅣstage(OS:P=0.011;PFS:P=0.003)were independent risk factors for increased risk of death.Overweight(OS:P=0.001;PFS:P=0.004)was an indicator of reduced mortality risk.Kaplan-Meier survival curve analysis showed that BMI and serum albumin levels were significantly associated with OS and PFS(P<0.001).Conclusions:The findings suggest that BMI,age,serum albumin,PS scores,CPS and clinical stage are significantly associated with the prognosis in R/M HNSCC patients treated with pembrolizumab and may serve as independent prognostic indicators of anti-PD-1 therapy in patients with R/M HNSCC.

关 键 词：程序性细胞死亡-1 头颈部鳞状细胞癌 体质量指数 肥胖悖论 血清白蛋白 

分 类 号：R739.91[医药卫生—肿瘤]