Potential role of Geriatric Nutritional Risk Index as a risk factor for immune-mediated adverse events during durvalumab plus tremelimumab therapy in unresectable hepatocellular carcinoma.

IF 5.5 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology Pub Date : 2025-08-20 DOI:10.1007/s00535-025-02290-4

Hideko Ohama, Atsushi Hiraoka, Toshifumi Tada, Masashi Hirooka, Kazuya Kariyama, Joji Tani, Masanori Atsukawa, Koichi Takaguchi, Ei Itobayashi, Shinya Fukunishi, Kunihiko Tsuji, Toru Ishikawa, Kazuto Tajiri, Hironori Tanaka, Hidenori Toyoda, Chikara Ogawa, Takashi Nishimura, Takeshi Hatanaka, Satoru Kakizaki, Kazuhito Kawata, Atsushi Naganuma, Hisashi Kosaka, Tomomitsu Matono, Hidekatsu Kuroda, Yutaka Yata, Hiroki Nishikawa, Michitaka Imai, Tomoko Aoki, Hironori Ochi, Hideyuki Tamai, Shohei Komatsu, Fujimasa Tada, Shinichiro Nakamura, Yoshiko Nakamura, Teruki Miyake, Osamu Yoshida, Kazuhiro Nouso, Asahiro Morishita, Norio Itokawa, Tomomi Okubo, Taeang Arai, Akemi Tsutsui, Takuya Nagano, Kazunari Tanaka, Takanori Matsuura, Yuichi Koshiyama, Yuki Kanayama, Hidenao Noritake, Hirayuki Enomoto, Kosuke Matsui, Masaki Kaibori, Takumi Fukumoto, Yoichi Hiasa, Masatoshi Kudo, Takashi Kumada

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引用次数: 0

Abstract

Background: Immune-mediated adverse events (imAEs) are a significant concern in patients with unresectable hepatocellular carcinoma (uHCC) undergoing combination immunotherapy with durvalumab and tremelimumab (Dur/Tre). This study aimed to investigate the potential association of risk factors, particularly nutrition and immune markers, associated with the development of imAEs.

Methods: Between November 2022 and December 2024, 312 patients with uHCC treated with Dur/Tre were enrolled and retrospectively analyzed. Clinical characteristics, inflammatory markers, and nutritional indices (Geriatric Nutritional Risk Index [GNRI], body mass index, Prognostic Nutritional Index-Onodera, C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio) were evaluated to identify predictors for imAE development.

Results: The imAEs occurred in 122 patients (39.1%), most commonly affecting dermatological, gastrointestinal, and endocrine systems. On multivariate analysis, only normal GNRI (≥ 98) was independently associated with a higher incidence of imAE (odds ratio: 1.99, 95% confidence interval: 1.05-3.79, P = 0.036). Patients with GNRI ≥ 98 also showed better overall survival (OS) than those with GNRI < 98 (not reached vs. 12.5 months, P < 0.001). Among patients who developed imAEs, no significant differences were observed in the imAE types or high-dose steroid use between the GNRI ≥ 98 group (n = 66) and the GNRI < 98 group (n = 56) (40.9% vs. 58.9%, P = 0.069).

Conclusions: Normal GNRI status (≥ 98) was associated with an increased risk of imAE development and improved OS in patients with uHCC receiving Dur/Tre therapy. GNRI may be a useful clinical factor for identifying patients at higher risk of developing imAEs.

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老年营养风险指数作为durvalumab加tremelimumab治疗不可切除肝细胞癌期间免疫介导不良事件的危险因素的潜在作用。

背景：在接受durvalumab和tremelimumab （Dur/Tre）联合免疫治疗的不可切除肝细胞癌（uHCC）患者中，免疫介导的不良事件（imae）是一个重要的问题。这项研究的目的是调查潜在的风险因素，特别是营养和免疫标记物，与影像的发展有关。方法：在2022年11月至2024年12月期间，对312例接受Dur/Tre治疗的uHCC患者进行回顾性分析。评估临床特征、炎症标志物和营养指标（老年营养风险指数[GNRI]、体重指数、预后营养指数- onodera、c反应蛋白与白蛋白比率、中性粒细胞与淋巴细胞比率、血小板与淋巴细胞比率），以确定imAE发展的预测因素。结果：122例（39.1%）患者出现影像学改变，多见于皮肤、胃肠和内分泌系统。在多变量分析中，只有正常GNRI（≥98）与较高的imAE发生率独立相关（优势比：1.99,95%可信区间：1.05-3.79,P = 0.036）。GNRI≥98的患者也比GNRI患者表现出更好的总生存期（OS）。结论：在接受Dur/Tre治疗的uHCC患者中，正常的GNRI状态（≥98）与影像学发展风险增加和OS改善相关。GNRI可能是一种有用的临床因素，用于识别发生影像学风险较高的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

12.20

自引率

1.60%

发文量

审稿时长

4-8 weeks

期刊介绍： The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.