Development and validation of a new tool to estimate early mortality in patients with advanced cancer treated with immunotherapy.

IF 4.6 2区 医学 Q2 IMMUNOLOGY Cancer Immunology, Immunotherapy Pub Date : 2024-10-03 DOI:10.1007/s00262-024-03836-w
Andrea De Giglio, Alessandro Leonetti, Francesca Comito, Daria Maria Filippini, Veronica Mollica, Karim Rihawi, Marianna Peroni, Giulia Mazzaschi, Ilaria Ricciotti, Francesca Carosi, Andrea Marchetti, Matteo Rosellini, Ambrogio Gagliano, Valentina Favorito, Elisabetta Nobili, Francesco Gelsomino, Barbara Melotti, Paola Valeria Marchese, Francesca Sperandi, Alessandro Di Federico, Sebastiano Buti, Fabiana Perrone, Francesco Massari, Maria Abbondanza Pantaleo, Marcello Tiseo, Andrea Ardizzoni
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引用次数: 0

Abstract

Background: Immune checkpoint inhibitors (ICIs) are standard treatments for advanced solid cancers. Resistance to ICIs, both primary and secondary, poses challenges, with early mortality (EM) within 30-90 days indicating a lack of benefit. Prognostic factors for EM, including the lung immune prognostic index (LIPI), remain underexplored.

Methods: We performed a retrospective, observational study including patients affected by advanced solid tumors, treated with ICI as single agent or combined with other agents. Logistic regression models identified factors associated with EM and 90-day progression risks. A nomogram for predicting 90-day mortality was built and validated within an external cohort.

Results: In total, 637 patients received ICIs (single agent or in combination with other drugs) for advanced solid tumors. Most patients were male (61.9%), with NSCLC as the prevalent tumor (61.8%). Within the cohort, 21.3% died within 90 days, 8.4% died within 30 days, and 34.5% experienced early progression. Factors independently associated with 90-day mortality included ECOG PS 2 and a high/intermediate LIPI score. For 30-day mortality, lung metastasis and a high/intermediate LIPI score were independent risk factors. Regarding early progression, high/intermediate LIPI score was independently associated. A predictive nomogram for 90-day mortality combining LIPI and ECOG PS achieved an AUC of 0.76 (95% CI 0.71-0.81). The discrimination ability of the nomogram was confirmed in the external validation cohort (n = 255) (AUC 0.72, 95% CI 0.64-0.80).

Conclusion: LIPI and ECOG PS independently were able to estimate 90-day mortality, with LIPI also demonstrating prognostic validity for 30-day mortality and early progression.

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开发并验证用于估算接受免疫疗法的晚期癌症患者早期死亡率的新工具。
背景:免疫检查点抑制剂(ICIs免疫检查点抑制剂(ICIs)是晚期实体瘤的标准疗法。对 ICIs 的耐药性(包括原发性和继发性)带来了挑战,30-90 天内的早期死亡率(EM)表明缺乏获益。包括肺免疫预后指数(LIPI)在内的EM预后因素仍未得到充分探讨:我们进行了一项回顾性观察研究,研究对象包括晚期实体瘤患者,他们接受了 ICI 单药治疗或与其他药物联合治疗。逻辑回归模型确定了与EM和90天进展风险相关的因素。建立了预测90天死亡率的提名图,并在外部队列中进行了验证:共有 637 名晚期实体瘤患者接受了 ICIs(单药或与其他药物联用)治疗。大多数患者为男性(61.9%),主要肿瘤为 NSCLC(61.8%)。在队列中,21.3%的患者在90天内死亡,8.4%的患者在30天内死亡,34.5%的患者病情出现早期进展。与90天死亡率独立相关的因素包括ECOG PS 2和高/中LIPI评分。就30天死亡率而言,肺转移和高/中LIPI评分是独立的风险因素。在早期进展方面,高/中LIPI评分是独立的相关因素。结合 LIPI 和 ECOG PS 的 90 天死亡率预测提名图的 AUC 为 0.76(95% CI 0.71-0.81)。外部验证队列(n = 255)证实了该提名图的区分能力(AUC 0.72,95% CI 0.64-0.80):结论:LIPI和ECOG PS能够独立估算90天死亡率,LIPI还显示出对30天死亡率和早期进展的预后有效性。
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来源期刊
CiteScore
10.50
自引率
1.70%
发文量
207
审稿时长
1 months
期刊介绍: Cancer Immunology, Immunotherapy has the basic aim of keeping readers informed of the latest research results in the fields of oncology and immunology. As knowledge expands, the scope of the journal has broadened to include more of the progress being made in the areas of biology concerned with biological response modifiers. This helps keep readers up to date on the latest advances in our understanding of tumor-host interactions. The journal publishes short editorials including "position papers," general reviews, original articles, and short communications, providing a forum for the most current experimental and clinical advances in tumor immunology.
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