皮肤免疫相关的不良反应与免疫检查点抑制剂治疗的晚期癌症患者的总体生存期延长相关：一个多机构队列研究。
Cutaneous immune-related adverse events are associated with longer overall survival in advanced cancer patients on immune checkpoint inhibitors: a multi-institutional cohort study.
发表日期：2023 Jan 31
作者：
Shijia Zhang, Kimberly Tang, Guihong Wan, Nga Nguyen, Chenyue Lu, Pearl Ugwu-Dike, Neel Raval, Jayhyun Seo, Nora A Alexander, Ruple Jairath, Jordan Phillipps, Bonnie W Leung, Kathleen Roster, Wenxin Chen, Leyre Zubiri, Genevieve Boland, Steven T Chen, Hensin Tsao, Shadmehr Demehri, Nicole R LeBoeuf, Kerry L Reynolds, Kun-Hsing Yu, Alexander Gusev, Shawn G Kwatra, Yevgeniy R Semenov
来源：
J Am Acad Dermatol
摘要：
皮肤免疫相关不良事件（cirAEs）在高达40％的免疫检查点抑制剂（ICI）接受者中发生。然而，cirAEs与生存的关联仍不清楚。为了调查cirAEs与ICI接受者生存之间的关联，从Mass General Brigham医疗保健系统（MGB）和Dana-Farber癌症研究所（DFCI）中确定ICI接受者。在ICI启动后的2年内检查病人的病历以了解cirAE发展情况。利用经过年龄、性别、种族/族裔、Charlson合并症指数、ICI类型、癌症类型和ICI启动年份调整的多元时间变化的Cox比例风险模型来研究cirAE发展对总体生存的影响。在3,731名ICI接受者中，18.1％出现cirAE。 6个月地标分析和时间变化的Cox比例风险模型表明，发生cirAE的患者与死亡率下降有关（HR = 0.87，p = 0.027），特别是对于黑色素瘤患者（HR = 0.67，p = 0.003）。在个人形态学中，苔藓样爆发（HR = 0.51，p <0.001）、银屑病样爆发（HR = 0.52，p = 0.005）、白癜风（HR = 0.29，p = 0.007）、无显着皮疹表现的孤立性瘙痒（HR = 0.71，p = 0.007）、 粉刺样爆发（HR = 0.34，p = 0.025）和非特异性皮疹（HR = 0.68，p <0.001）与多重比较调整后更好的生存显着相关。患者回顾性设计，单一地理位置。cirAE发展与ICI接受者的生存改善有关，特别是黑色素瘤患者。版权所有©2023年Elsevier Inc.发表。
Cutaneous immune-related adverse events (cirAEs) occur in up to 40% of immune checkpoint inhibitor (ICI) recipients. However, the association of cirAEs with survival remains unclear.To investigate the association of cirAEs with survival among ICI recipients.ICI recipients were identified from the Mass General Brigham healthcare system (MGB) and Dana-Farber Cancer Institute (DFCI). Patient charts were reviewed for cirAE development within 2 years after ICI initiation. Multivariate time-varying Cox proportional hazards models, adjusted for age, sex, race/ethnicity, Charlson Comorbidity Index, ICI type, cancer type, and year of ICI initiation were utilized to investigate the impact of cirAE development on overall survival.Of the 3,731 ICI recipients, 18.1% developed a cirAE. 6-month landmark analysis and time-varying Cox proportional hazards models demonstrated that patients who developed cirAEs were associated with decreased mortality (HR=0.87,p=0.027), particularly in melanoma patients (HR=0.67,p=0.003). Among individual morphologies, lichenoid eruption (HR=0.51,p<0.001), psoriasiform eruption (HR=0.52,p=0.005), vitiligo (HR=0.29,p=0.007), isolated pruritus without visible manifestation of rash (HR=0.71,p=0.007), acneiform eruption (HR =0.34,p=0.025), and non-specific rash (HR=0.68, p<0.001) were significantly associated with better survival after multiple comparisons adjustment.Retrospective design; single geography.CirAE development is associated with improved survival among ICI recipients, especially melanoma patients.Copyright © 2023. Published by Elsevier Inc.