Introduction: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC); however, validating body composition-related biomarkers for their efficacy remains incomplete. We evaluated the association between body composition-related markers and the prognosis of patients with mRCC who received ICI-based first-line therapies. Patients and Methods: We retrospectively investigated 60 patients with mRCC who underwent ICI-based therapy as their first-line treatment between 2019 and 2023. Body composition variables, including skeletal muscle, subcutaneous fat, and visceral fat indices, were calculated using baseline computed tomography scans. Sarcopenia was defined according to sex-specific cut-off values of the skeletal mass index. The associations between body composition indices and objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were evaluated. Results: Patients with sarcopenia had lower ORR and DCR than those without sarcopenia (33.3% vs. 61.1%,p= 0.0436 and 52.4% vs. 94.4%,p= 0.0024, respectively). Patients with sarcopenia had a significantly shorter median PFS (14 months vs. not reached,p= 0.0020) and OS (21 months vs. not reached,p= 0.0023) than patients without sarcopenia did. Sarcopenia was a significant predictor of PFS (hazard ratio [HR], 4.31; 95% confidence interval [CI], 1.65–14.8;p= 0.0018) and OS (HR, 5.44; 95% CI, 1.83–23.4;p= 0.0013) along with poor IMDC risk. No association was found between the subcutaneous, visceral, and total fat indices and the therapeutic effect of ICI-based therapy. Conclusions: Sarcopenia was associated with a lower response and shorter survival rates in patients with mRCC who received first-line ICI-based therapy.
引言：免疫检查点抑制剂（ICIs）已彻底改变转移性肾细胞癌（mRCC）的治疗格局，然而其疗效相关的身体成分生物标志物验证仍不完善。本研究旨在评估身体成分相关标志物与接受一线ICI治疗的mRCC患者预后的关联。 患者与方法：我们回顾性分析了2019年至2023年间接受一线ICI治疗的60例mRCC患者。基于基线计算机断层扫描图像计算身体成分参数，包括骨骼肌指数、皮下脂肪指数和内脏脂肪指数。根据性别特异性骨骼肌质量指数临界值定义肌肉减少症。评估身体成分指数与客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）和总生存期（OS）的关联。 结果：肌肉减少症患者的ORR和DCR均显著低于非肌肉减少症患者（分别为33.3% vs. 61.1%，p=0.0436；52.4% vs. 94.4%，p=0.0024）。肌肉减少症患者的中位PFS（14个月 vs. 未达到，p=0.0020）和OS（21个月 vs. 未达到，p=0.0023）显著缩短。在多因素分析中，肌肉减少症与不良IMDC风险同为PFS（风险比[HR]=4.31，95%置信区间[CI] 1.65-14.8，p=0.0018）和OS（HR=5.44，95%CI 1.83-23.4，p=0.0013）的独立预测因子。皮下脂肪、内脏脂肪及总脂肪指数与ICI治疗效果未见显著关联。 结论：在接受一线ICI治疗的mRCC患者中，肌肉减少症与治疗反应率降低及生存期缩短显著相关。
肿瘤(癌症)患者之家