Body Composition and Inflammation as Emerging Sex-Specific Prognostic Factors in Patients with Advanced Cutaneous Melanoma Undergoing Immune Checkpoint-Inhibition Therapy: A Prospective Pilot Study.
Jana Knuever, Oana-Diana Persa, Lukas Gerecht, Max Schlaak, Sebastian Theurich
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引用次数: 0
Abstract
Introduction: The distribution of muscle and adipose tissues masses physiologically follow sex-specific patterns. On the other hand, the clinical and biological consequences of pathologic body composition, i.e., sarcopenia or obesity, also depend on tissue distribution patterns. Although obesity-associated inflammation has been correlated with survival benefits of cancer patients undergoing immune checkpoint inhibition (ICI) therapy, detailed and sex-specific body composition analyses are widely missing. Here, we prospectively analyzed body composition and serum parameters of inflammation and protein metabolism in patients with advanced melanoma before and 3 months after initiation of ICI therapy.
Methods: Between 2016 and 2018, consecutive patients with advanced cutaneous melanoma were recruited into the study at our cancer center (Skin Cancer Center, CIO, University Hospital Cologne, Germany). Blood samples and body composition based on bioelectrical impedance analysis (BIA) were assessed before ICI therapy initiation (T1) and after 3 months (T2). Correlation of blood parameters with body composition as well as progression-free (PFS) and overall survival (OS) was analyzed in sex-specific subgroups.
Results: From a total of 54 patients, 25 were women and 29 were men. In women, a high muscle mass at T1 was the strongest marker for longer PFS (HR 0.84; 95% CI: 0.74-0.98; p = 0.024), while in men (n = 29), high phase angle values at T1 correlated with significantly longer PFS (HR 0.48; 95% CI: 0.26-0.90; p = 0.023). Regarding OS, muscle mass status at T1 remained the strongest predictor for longer survival in women (HR 0.85; 95% CI: 0.72-0.99; p = 0.033), while in men, increased leukocyte blood counts at T1 were associated with the poorest OS (HR 1.36; 95% CI: 1.14-1.62; p = 0.001). Inflammation and the immuno-nutritional score mGPS correlated with body composition parameters in a sex-specific manner. However, we did not observe an impact of dynamic changes between T1 and T2 in all analyzed parameters.
Conclusion: Our data suggest that BIA-derived markers are associated with the prognosis of melanoma patients undergoing ICI therapy in a sex-specific manner. Selected body composition parameters correlate differently with blood markers of inflammation and protein metabolism in men and women. If validated in larger trials, these assessments might improve individualized supportive care and clinical risk stratification.
期刊介绍：
With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.
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