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2026年8月29日星期六
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炎症营养指数在食管癌免疫检查点抑制剂治疗中的预后价值：治疗依赖性与非依赖性

Treatment-dependent and independent prognostic value of inflammation-based nutritional indices in immune checkpoint inhibitor-based therapy for esophageal cancer.

期刊
Esophagus
PMID
42663915
原文
PubMed ↗
发布日期

作者

  • Hiroki Matsuda — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Tomoki Makino — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan. tmakino@gesurg.med.osaka-u.ac.jp.
  • Shuichiro Hara — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Shigeto Nakai — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Takaomi Hagi — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Kota Momose — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Kotaro Yamashita — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Takuro Saito — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Koji Tanaka — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Atsushi Takeno — Department of Surgery, NHO Osaka National Hospital, Osaka, Japan.
  • Tsuyoshi Takahashi — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Masaaki Motoori — Department of Surgery, Osaka General Medical Center, Osaka, Japan.
  • Yukinori Kurokawa — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Hidetoshi Eguchi — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Yuichiro Doki — Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.

作者单位

  • Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
  • Department of Gastroenterological Surgery, Graduate School of Medicine, The University of Osaka, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan. tmakino@gesurg.med.osaka-u.ac.jp.
  • Department of Surgery, NHO Osaka National Hospital, Osaka, Japan.
  • Department of Surgery, Osaka General Medical Center, Osaka, Japan.

摘要

中文

III期试验已确立了免疫治疗对不可切除的晚期或复发性食管鳞状细胞癌（ESCC）的疗效。然而，比较不同方案和临床适用的预后生物标志物的真实世界证据仍然有限。我们回顾性评估了245例不可切除的晚期/复发性ESCC患者，这些患者接受了一线5-氟尿嘧啶联合顺铂加纳武利尤单抗或帕博利珠单抗（CF+ICI；n=114）、一线伊匹木单抗联合纳武利尤单抗（Ipi+Nivo；n=46）或纳武利尤单抗单药作为二线或后线治疗（Nivo；n=85）。评估疗效、安全性和生存结局，重点关注基于炎症的营养指数和多变量预后建模。客观缓解率分别为56%、53%和27%，中位总生存期分别为26、73和13个月。未发生治疗相关死亡。多变量分析中，Glasgow预后评分（GPS）≥2在所有方案中独立预测较差的生存。高血小板与淋巴细胞比值（PLR）仅在无化疗的ICI方案（Ipi+Nivo和Nivo）中与较差的生存独立相关。合并模型显示治疗方案与PLR之间存在显著交互作用（p=0.047）。在真实世界实践中，GPS提供了独立于治疗方案的预后分层，而PLR显示出治疗依赖的预后相关性，支持其在ESCC中基于生物标志物的个体化治疗选择中的潜在用途。

English

Phase III trials have established the efficacy of immune-based therapies for unresectable advanced or recurrent esophageal squamous cell carcinoma (ESCC). However, real-world evidence comparing regimens and clinically applicable prognostic biomarkers remains limited. We retrospectively evaluated 245 patients with unresectable advanced/recurrent ESCC treated with first-line 5-fluorouracil plus cisplatin combined with nivolumab or pembrolizumab (CF + ICI; n = 114), first-line ipilimumab plus nivolumab (Ipi + Nivo; n = 46), or nivolumab monotherapy as second-line or later treatment (Nivo; n = 85). Efficacy, safety, and survival outcomes were assessed, focusing on inflammation-based nutritional indices and multivariate prognostic modelling. The objective response rates were 56%, 53%, and 27%, and the median overall survival was 26, 73, and 13 months in the CF + ICI, Ipi + Nivo, and Nivo groups, respectively. No treatment-related deaths occurred. In multivariate analyses, Glasgow Prognostic Score (GPS) ≥ 2 independently predicted poor survival across all regimens. High platelet-to-lymphocyte ratio (PLR) was independently associated with poor survival only in chemotherapy-free ICI regimens (Ipi + Nivo and Nivo). A pooled model showed a significant interaction between treatment regimen and PLR (p = 0.047). In real-world practice, GPS provides regimen-independent prognostic stratification, whereas PLR shows treatment-dependent prognostic relevance, supporting its potential utility for biomarker-guided and individualized treatment selection in ESCC.

分类与指标

研究类型
临床研究
病种
食管癌
JCR 分区
Q1
影响因子
5.8
新锐分区
4区