在用地塞米松缓解癌症患者呼吸困难 (ABCD) 试验中，对于未选择的癌症患者，地塞米松并没有比安慰剂更能改善呼吸困难。然而，尚不清楚炎症较重的患者是否更有可能获得治疗反应。为了检查细胞因子对呼吸困难反应的预测效用。我们对比较高剂量的 ABCD 双盲、随机临床试验进行了二次分析地塞米松与安慰剂 (NCT03367156)。主要结果是 14 天内的呼吸困难强度。在基线、第 7 天和第 14 天测量血液细胞因子水平（TNF、IL-6、IL-8 和 IL-10）。我们使用广义相加模型来检查基线细胞因子水平与呼吸困难变化之间的关联地塞米松组和安慰剂组的基线至第 7 天和基线至第 14 天。在 128 名入组患者中，45 名提供了血液样本。地塞米松组的 TNF、IL-6 和 IL-8 在 14 天内有所下降，但安慰剂组没有下降（P<0.05）。在安慰剂组中，较低的基线 TNF 与第七天呼吸困难强度的更大程度降低相关（P=0.0013）；相反，地塞米松组中较高的基线 TNF 与第 7 天呼吸困难强度的更大程度降低相关（组间差异 P=0.0019）。在第 7 天的 IL-6 (P=0.000051)、IL-8 (P=0.00063) 和 IL-10 (P=0.01) 以及第 14 天的所有细胞因子中观察到类似的模式。细胞因子随地塞米松减少，但不增加安慰剂。较高的基线细胞因子水平可能会识别出可能对地塞米松有反应而不太可能对安慰剂有反应的患者。版权所有 © 2024 美国临终关怀和姑息医学学会。由爱思唯尔公司出版。保留所有权利。

In the Alleviating Breathlessness in Cancer Patients with Dexamethasone (ABCD) trial, dexamethasone did not improve dyspnea more than placebo in unselected cancer patients. However, it is unclear if patients with greater inflammation would be more likely to derive a treatment response.To examine the predictive utility of cytokines for dyspnea response.We performed a secondary analysis of the ABCD double-blind, randomized clinical trial comparing high-dose dexamethasone to placebo (NCT03367156). The primary outcome was dyspnea intensity over 14 days. Blood cytokine levels (TNF, IL-6, IL-8, and IL-10) were measured at baseline, day seven, and day 14. We used a generalized additive model to examine the association between baseline cytokine level and change in dyspnea from baseline to day seven and baseline to day 14 in dexamethasone and placebo groups.Of the 128 enrolled patients, 45 provided blood samples. TNF, IL-6, and IL-8 decreased over 14 days in the dexamethasone group but not placebo (P<0.05). Lower baseline TNF was associated with a greater reduction in dyspnea intensity by day seven in the placebo group (P=0.0013); conversely, higher baseline TNF was associated with a greater reduction in dyspnea intensity by day 7 in the dexamethasone group (difference between groups P=0.0019). Similar patterns were observed for IL-6 (P=0.000051), IL-8 (P=0.00063), and IL-10 (P=0.01) on day seven, and all cytokines on day 14.Cytokines decreased with dexamethasone, but not placebo. Higher baseline cytokine levels may identify patients likely to respond to dexamethasone and less likely to respond to placebo.Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.