[18F]FDG PET/CT显示的动脉炎在接受与未接受免疫检查点抑制剂治疗的黑色素瘤患者中的表现：CHECK-FLAME I研究
Arterial inflammation on [18F]FDG PET/CT in melanoma patients treated with and without immune checkpoint inhibitors: CHECK-FLAME I
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影响因子:5.7
分区:医学2区 Top / 外周血管病2区 心脏和心血管系统3区
发表日期:2024 Nov
作者:
Elissa A S Polomski, Ellen W Kapiteijn, Julius C Heemelaar, Anne V van der Kolk, Timo M Kalisvaart, Alina van de Burgt, Petra Dibbets-Schneider, Floris H P van Velden, Tom T P Seijkens, J Lauran Stöger, J Wouter Jukema, Lioe-Fee de Geus-Oei, M Louisa Antoni
DOI:
10.1016/j.atherosclerosis.2024.118595
摘要
免疫检查点抑制剂（ICIs）革新了癌症治疗，但其可能增加对非肿瘤细胞的免疫反应，从而引发动脉炎，增加动脉粥样硬化事件的风险。然而，恶性肿瘤可能诱发促炎状态，ICIs与动脉炎的关系尚待阐明。本研究旨在评估接受ICIs治疗的晚期黑色素瘤患者与未接受ICIs的对照组在动脉炎变化上的差异。我们纳入了接受[18F]FDG PET/CT扫描的晚期黑色素瘤患者，扫描时间点为基线、6个月（T1）和18个月（T2）。通过计算目标与背景比值（TBR）在八个血管段评估动脉炎。主要研究指标是接受与未接受ICIs治疗的患者之间TBRmax平均值升高的差异。共纳入132名患者，其中72.7%接受了ICIs治疗。排除使用抗炎药物后，接受ICIs的患者在基线至T1期间，TBRmax平均值从1.29±0.12升至1.33±0.13（p=0.017），而对照组无显著变化（1.30±0.12至1.28±0.10，p=0.22），两组TBRmax变化的差异有统计学意义（p=0.027）。在较长随访期内，两组的TBRmax均保持稳定。接受ICIs治疗的患者中，无活动性炎症（p<0.001）和无钙化病变（p=0.013）的患者，其动脉炎显著增加。仅在治疗开始的前六个月，接受ICIs的黑色素瘤患者显示动脉炎显著升高，而对照组未见变化。此外，动脉炎主要增加于无既存炎症活动和无钙化病变的患者中。
Abstract
Immune checkpoint inhibitors (ICIs) revolutionized cancer treatment. However, ICIs may increase the immune response to non-tumor cells, possibly resulting in increased arterial inflammation, raising the risk of atherosclerotic events. Nevertheless, malignancies may induce a pro-inflammatory state and the association between ICIs and arterial inflammation remains to be clarified. This study aims to assess differences in increase in arterial inflammation between patients with advanced melanoma treated with ICIs compared to a control group without ICIs.Patients with advanced melanoma who underwent [18F]FDG PET/CT scans at baseline, 6 months (T1) and 18 months (T2) were included in this retrospective observational study. Arterial inflammation was evaluated in eight segments by calculating the target-to-background ratio (TBR). The primary study outcome was the difference in increase in mean TBRmax between patients treated with and without ICIs.We included 132 patients of whom 72.7 % were treated with ICIs. After exclusion for the use of anti-inflammatory medication, patients treated with ICIs showed a significant increase in mean TBRmax between baseline and T1 from 1.29 ± 0.12 to 1.33 ± 0.13 (p = 0.017), while in the control group, no change in mean TBRmax (1.30 ± 0.12 to 1.28 ± 0.10, p = 0.22) was observed (p = 0.027). During longer follow-up, mean TBRmax remained stable in both groups. Arterial inflammation increased significantly after ICI therapy in patients without active inflammation (p < 0.001) and in patients without calcifications (p = 0.013).A significant increase in arterial inflammation as measured on [18F]FDG PET/CT was observed in patients with advanced melanoma treated with ICIs only in the first six months after initiation of therapy, whereas no changes were observed in the control group. Moreover, arterial inflammation was mainly increased in patients without pre-existing inflammatory activity and with non-calcified lesions.