糖尿病增加转移性非小细胞肺癌免疫治疗相关毒性但不影响疗效：一项多中心回顾性研究
Diabetes Increases Immunotherapy-Related Toxicity but Not Efficacy in Metastatic Non-Small Cell Lung Cancer: A Multicenter Retrospective Study.
作者
作者单位
- Department of Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
- Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Turkey.
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
- Department of Medical Oncology, Pamukkale University Faculty of Medicine, Denizli, Turkey.
- Department of Medical Oncology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey.
- Department of Medical Oncology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
- Department of Medical Oncology, Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey.
- Department of Medical Oncology, Marmara University Faculty of Medicine, İstanbul, Turkey.
- Department of Medical Oncology, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya, Turkey.
- Department of Medical Oncology, Manisa Celal Bayar University Faculty of Medicine., Manisa, Turkey.
- Department of Medical Oncology, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey.
- Department of Medical Oncology, Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey.
- Department of Medical Oncology, Tekirdağ Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey.
- Department of Medical Oncology, Hg Hospital, Kahramanmaraş, Turkey.
- Department of Medical Oncology, Inonu University Faculty of Medicine, Malatya, Turkey.
- Department of Medical Oncology, Aksaray Training and Research Hospital, Aksaray, Turkey.
- Department of Medical Oncology, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyon, Turkey.
- Department of Medical Oncology, Liv Hospital Ankara, Ankara, Turkey.
- Department of Medical Oncology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.
- Department of Medical Oncology, İstinye University Liv Hospital Topkapı, İstanbul, Turkey.
- Department of Medical Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
摘要
中文
这项多中心回顾性研究评估了 2 型糖尿病（DM）对 2016 年至 2024 年在 17 个中心接受二线 nivolumab 治疗的 450 名转移性非小细胞肺癌（NSCLC）患者临床结局和免疫相关不良事件（irAEs）的影响。在这些患者中，118 名（26.2%）患有 DM。包括年龄、性别、吸烟状况、ECOG 体能状态、组织学和 PD-L1 表达在内的基线人口统计学和临床特征在患有和不患有 DM 的患者之间相似。Nivolumab 在两组中显示出相似的抗肿瘤活性，中位无进展生存期（PFS）、总生存期（OS）或客观缓解率无显著差异。然而，3-4 级 irAEs 的发生率在 DM 患者中显著更高。在单变量分析中，HbA1c 水平与生存结局无关，二甲双胍或胰岛素使用不影响 DM 患者的 PFS 或 OS。这些发现表明，DM 不损害免疫治疗疗效，但与严重毒性风险增加相关。临床医生应考虑代谢状态并密切监测接受免疫治疗的 DM 患者。需要进一步的前瞻性研究来阐明潜在机制并优化该人群的治疗策略。
English
This multicenter retrospective study evaluated the impact of type 2 diabetes mellitus (DM) on clinical outcomes and immune-related adverse events (irAEs) in 450 patients with metastatic non-small cell lung cancer (NSCLC) treated with second-line nivolumab at 17 centers between 2016 and 2024. Among these patients, 118 (26.2%) had DM. Baseline demographic and clinical characteristics, including age, sex, smoking status, ECOG performance status, histology, and PD-L1 expression, were similar between patients with and without DM. Nivolumab demonstrated similar antitumor activity in both groups, with no significant differences in median progression-free survival (PFS), overall survival (OS), or objective response rates. However, the incidence of Grade 3-4 irAEs was significantly higher in patients with DM. HbA1c levels were not associated with survival outcomes in univariate analyses, and metformin or insulin use did not affect PFS or OS among patients with DM. These findings indicate that DM does not compromise immunotherapy efficacy but is associated with a higher risk of severe toxicity. Clinicians should consider metabolic status and closely monitor patients with DM receiving immunotherapy. Further prospective studies are needed to clarify underlying mechanisms and optimize treatment strategies for this population.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q2
- 影响因子
- 4.9
- 新锐分区
- 2区