Prognostic impact of neutrophil-to-lymphocyte ratio (NLR) in patients with unresectable biliary tract cancer treated with gemcitabine, cisplatin, and durvalumab.

IF 2.5 3区 医学 Q3 ONCOLOGY
Satoshi Mii, Hiroyuki Kato, Takeshi Takahara, Masayuki Kojima, Yutaro Kato, Zenichi Morise, Akihiko Horiguchi, Koichi Suda
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引用次数: 0

Abstract

Background: Biliary tract cancer (BTC) is a type of malignancy that is challenging to manage. Further, advanced-stage BTC has poor prognosis. Based on the recent TOPAZ-1 trial, adding durvalumab to gemcitabine and cisplatin significantly improves survival in unresectable BTC, thereby making it the new standard first-line treatment. However, real-world data are essential to validate its efficacy and safety in routine clinical settings, which often involve older patients and those with comorbidities or previous therapies. This study aimed to evaluate the outcomes of combination chemotherapy with gemcitabine, cisplatin, and durvalumab (GCD) in a real-world cohort with BTC.

Methods: This retrospective analysis included patients with unresectable advanced-stage BTC treated with GCD between December 2022 and April 2024 at three institutions. GCD was administered for up to eight cycles, followed by durvalumab monotherapy. Clinical data, including the characteristics of the patients, adverse events, and treatment responses, were collected. The Kaplan-Meier method and the Cox proportional hazards model were used to assess progression-free survival (PFS), overall survival (OS), and other factors affecting outcomes.

Results: The current study included 54 patients with a median age of 72 years. Half of the patients had recurrence post-surgery, and many of them had previously received chemotherapy. The median PFS and OS rates were 4.1 and 8.0 months, respectively. Adverse events (AEs) were frequently observed, with 42.1% of patients presenting with grade 3 or higher AEs. However, immune-related AEs were rare and mild. Dose adjustments, which are often caused by renal impairment or fatigue, were common (66.7%). Multivariate analysis revealed that older age, a lower performance status score, and a high neutrophil-to-lymphocyte ratio (NLR) were significant predictors of a shorter PFS. Further, a lower performance status score, and a high NLR were associated with a low OS.

Conclusions: GCD combination chemotherapy is a viable treatment option for advanced-stage BTC in a real-world setting where dose modifications can improve tolerability among elderly patients. Neutrophil-to-lymphocyte ratio can be a prognostic biomarker of OS in patients with BTC receiving immune checkpoint inhibitors. This finding highlights the potential of individualized treatment strategies. Nevertheless, further research should be performed to validate these results in larger cohorts.

中性粒细胞与淋巴细胞比率(NLR)对接受吉西他滨、顺铂和杜伐单抗治疗的不可切除胆道癌患者预后的影响
背景:胆道癌(BTC)是一种具有挑战性的恶性肿瘤。此外,晚期BTC预后较差。根据最近的TOPAZ-1试验,在吉西他滨和顺铂的基础上添加durvalumab可显著提高不可切除BTC的生存率,从而使其成为新的标准一线治疗。然而,真实世界的数据对于验证其在常规临床环境中的有效性和安全性至关重要,这些临床环境通常涉及老年患者和有合并症或既往治疗的患者。本研究旨在评估吉西他滨、顺铂和杜伐单抗(GCD)联合化疗在现实世界BTC队列中的结果。方法:回顾性分析2022年12月至2024年4月在三家机构接受GCD治疗的不可切除晚期BTC患者。GCD治疗长达8个周期,随后是杜伐单抗单药治疗。收集临床资料,包括患者特征、不良事件和治疗反应。Kaplan-Meier法和Cox比例风险模型用于评估无进展生存期(PFS)、总生存期(OS)和其他影响结果的因素。结果:目前的研究包括54例患者,中位年龄为72岁。一半的患者术后复发,其中许多人之前接受过化疗。中位PFS和OS分别为4.1和8.0个月。不良事件(ae)经常被观察到,42.1%的患者出现3级或更高的ae。然而,与免疫相关的不良反应是罕见和轻微的。剂量调整通常是由肾脏损害或疲劳引起的(66.7%)。多因素分析显示,年龄较大、较低的表现状态评分和较高的中性粒细胞与淋巴细胞比率(NLR)是较短PFS的显著预测因素。此外,较低的性能状态评分和较高的NLR与较低的OS相关。结论:GCD联合化疗是现实世界中晚期BTC的可行治疗选择,剂量调整可以提高老年患者的耐受性。中性粒细胞与淋巴细胞比率可以作为接受免疫检查点抑制剂的BTC患者OS的预后生物标志物。这一发现突出了个体化治疗策略的潜力。然而,应该进行进一步的研究以在更大的队列中验证这些结果。
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来源期刊
CiteScore
4.70
自引率
15.60%
发文量
362
审稿时长
3 months
期刊介绍: World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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