免疫相关性甲状腺功能异常与晚期胃癌患者免疫治疗疗效预后转归的关系  

Relationship between TFA-irAEs and prognosis outcomes of immunotherapy efficacy in patients with advanced gastric cancer

作　　者：孔祥蕾 卢熹微 曹军丽[1] 高立明[1] 刘娇[1] 邸娅[1] KONG Xianglei;LU Xiwei;CAO Junli;GAO Liming;LIU Jiao;DI Ya(Department of Oncology,Qinhuangdao First Hospital,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市第一医院肿瘤科,河北秦皇岛066000

出　　处：《西部医学》2024年第9期1327-1331,共5页Medical Journal of West China

基　　金：河北省2023年度医学科学研究课题(20231891)。

摘　　要：目的分析免疫相关性甲状腺功能异常(TFA-irAEs)与晚期胃癌患者免疫治疗疗效预后转归的关系。方法选取2020年3月—2022年3月期间于本院接受程序性死亡受体-1(PD-1)或程序性死亡配体1(PD-L1)抑制剂治疗的晚期胃癌患者106例,根据治疗过程中是否发生TFA-irAEs分为TFA-irAEs组与非TFA-irAEs组,比较两组临床特征,基于Logistic回归分析影响晚期胃癌患者发生TFA-irAEs的危险因素,并比较两组无进展生存时间(PFS)和总生存时间(OS)。结果106例晚期胃癌患者中,33例在治疗后出现TFA-irAEs,发生率为31.13%;TFA-irAEs组基线TSH水平、初始TPOAb/TgAb阳性率显著高于非TFA-irAEs组(P<0.05);多因素Logistic回归分析显示,基线TSH水平、初始TPOAb/TgAb阳性是影响晚期胃癌患者发生TFA-irAEs的危险因素(P<0.05);ROC诊断曲线结果显示,以2.16 mIU/L为最佳截点值,基线TSH预测晚期胃癌患者发生TFA-irAEs的敏感度为78.80%,特异度为75.30%,AUC为0.703(95%CI:0.596~0.810);绘制Kaplan-Meier生存曲线显示,TFA-irAEs组中位PFS和中位OS均明显长于非TFA-irAEs组(Log-rankχ^(2)=13.651,P<0.001;Log-rankχ^(2)=5.149,P=0.023)。结论基线TSH水平、初始TPOAb/TgAb阳性是影响晚期胃癌患者发生TFA-irAEs的危险因素,而TFA-irAEs与晚期胃癌患者免疫治疗疗效更佳预后转归有关。Objective To analyze the relationship between thyroid function abnormality immune-related adverse events(TFA-irAEs)and prognosis outcomes of immunotherapy efficacy in patients with advanced gastric cancer based on Logistic regression analysis.Methods 106 patients with advanced gastric cancer who received treatment with programmed death receptor-1(PD-1)or programmed death ligand 1(PD-L1)inhibitor in hospital from March 2020 to March 2022 were selected and divided into TFA-irAEs group and non-TFA-irAEs group according to whether TFA-irAEs occurred during treatment.The clinical features of the two groups were compared,and the risk factors affecting TFA-irAEs in patients with advanced gastric cancer were analyzed based on Logistic regression analysis,and the progression-free survival(PFS)and overall survival(OS)were compared between the two groups.Results Among 106 patients with advanced gastric cancer,33 cases developed TFA-irAEs after treatment,with the incidence rate of 31.13%.The baseline TSH level and initial TPOAb/TgAb positive rate in TFA-irAEs group were significantly higher than those in non-TFA-irAEs group(P<0.05).Multivariate Logistic regression analysis showed that baseline TSH level and positive initial TPOAb/TgAb were risk factors for TFA-irAEs occurrence inpatients with advanced gastric cancer(P<0.05).ROC diagnostic curve results showed that with 2.16mIU/L as the best cut-off value,the sensitivity and specificity of baseline TSH in predicting TFA-irAEs in patients with advanced gastric cancer were 78.80%and 75.30%,and AUC was 0.703(95%CI:0.596-0.810).Kaplan-Meier survival curve showed that the median PFS and median OS in TFA-irAEs group were significantly longer than those in non-TFA-irAEs group(Log-rankχ^(2)=13.651,P<0.001;Log-rankχ^(2)=5.149,P=0.023).Conclusion Baseline TSH level and positive initial TPOAb/TgAb are risk factors for TFA-irAEs in patients with advanced gastric cancer,and TFA-irAEs is associated with good prognosis outcomes of immunotherapy efficacy in patients with advanced gastric c

关 键 词：免疫相关不良事件 甲状腺功能异常 晚期胃癌 预后转归 

分 类 号：R735.2[医药卫生—肿瘤]