Background: Melanoma management has been revolutionized by the use of immune checkpoint inhibitors (ICIs). However, ICIs are associated with immune-related adverse events (irAEs), including rhinosinusitis, which remains underexplored. This study evaluated the incidence, characteristics, management, and prognostic implications of rhinosinusitis in patients with melanoma under ICIs.Methods: A retrospective analysis was conducted on adult patients with melanoma treated with ICIs. Demographic, clinical, laboratory, treatment, and survival data were collected. Rhinosinusitis was defined radiographically and graded using the Harvard scoring system. Associations between rhinosinusitis and survival outcomes were analyzed.Results: Among 304 patients, 64 (21.1%) developed imaging-confirmed rhinosinusitis during ICI treatment, with 9.4% symptomatic cases. Rhinosinusitis was the sole irAE in 11.8% of patients, and 9.2% experienced it alongside other irAEs. A significant correlation with eosinophilia was observed: 39.6% of eosinophilic patients developed rhinosinusitis versus 17.1% without eosinophilia (p< 0.001). Most cases occurred during the first ICI line (86.4%), particularly with nivolumab monotherapy (32.8%). Importantly, in metastatic melanoma, rhinosinusitis was associated with significantly longer overall survival since ICI initiation (OSICI) compared to patients without rhinosinusitis (33.3 vs. 15.4 months,p= 0.025). No survival benefit was observed in the adjuvant setting. The condition was predominantly aseptic, and corticosteroids were used in 7.8%.Conclusions: This study highlights rhinosinusitis as an irAE associated with improved OS in metastatic melanoma. Further research is required to elucidate the underlying mechanisms and assess the resolution of rhinosinusitis after ICI discontinuation. Additionally, rhinosinusitis may serve as a marker of favorable prognosis in metastatic melanoma patients receiving ICIs.
背景：免疫检查点抑制剂（ICIs）的应用已彻底改变了黑色素瘤的治疗模式。然而，ICIs会引发免疫相关不良事件（irAEs），其中鼻窦炎尚未得到充分研究。本研究旨在评估接受ICIs治疗的黑色素瘤患者中鼻窦炎的发生率、临床特征、处理方式及其对预后的影响。 方法：对接受ICIs治疗的成年黑色素瘤患者进行回顾性分析。收集人口统计学、临床、实验室检查、治疗及生存数据。鼻窦炎通过影像学确诊，并采用哈佛评分系统进行分级。分析鼻窦炎与生存结局之间的关联。 结果：在304例患者中，64例（21.1%）在ICI治疗期间出现影像学证实的鼻窦炎，其中9.4%有临床症状。11.8%的患者中鼻窦炎为唯一irAE，9.2%的患者同时伴有其他irAEs。研究发现鼻窦炎与嗜酸性粒细胞增多显著相关：嗜酸性粒细胞增多患者中39.6%发生鼻窦炎，而无嗜酸性粒细胞增多者仅为17.1%（p<0.001）。多数病例发生在首次ICI治疗期间（86.4%），尤其是纳武利尤单抗单药治疗（32.8%）。重要的是，在转移性黑色素瘤患者中，与未发生鼻窦炎者相比，发生鼻窦炎的患者自ICI治疗开始的总生存期（OSICI）显著延长（33.3个月 vs. 15.4个月，p=0.025）。在辅助治疗背景下未观察到生存获益。该病症主要为无菌性炎症，仅7.8%的患者使用了皮质类固醇治疗。 结论：本研究揭示鼻窦炎作为一种irAE，与转移性黑色素瘤患者总生存期的改善相关。需要进一步研究阐明其潜在机制，并评估停用ICIs后鼻窦炎的转归情况。此外，鼻窦炎可能作为接受ICIs治疗的转移性黑色素瘤患者预后良好的标志物。
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