Eur J Cancer:ICI 治疗的泌尿生殖系统癌患者的免疫相关不良事件和肾功能下降的发生情况

2021-09-13 Nebula MedSci原创

irAE 可能是接受 ICI 治疗的患者肾功能下降的新危险因素

泌尿生殖系统癌症患者采用免疫检查点抑制剂 (ICIs) 治疗对肾功能的影响尚不清楚。

本研究是一项回顾性队列研究,纳入了于2012年至2018年在两大癌症中心接受 ICI 治疗的肾细胞癌(RCC)和尿路上皮癌患者。主要结局是急性肾损伤(AKI)和持续性的估计肾小球滤过率 (eGFR) 降低(定义:eGFR降低>20% 持续 90天及以上)。采用相应风险模型明确主要结局的预测因子,并在存活1年及以上的患者中评估了免疫相关不良事件(irAE)和不良肾脏结局的相关性。

两种癌症患者eGFR降低>20%的累积发生率

共纳入了 637位患者:320位(50%)患者为 RCC,317位(50%)为尿路上皮癌。基线时一半的患者的 eGFR<60 mL/min/1.73 m2。irAE、AKI和持续性 eGFR 降低均很常见,发生率分别是 33%、25%和16%。与尿路上皮癌患者相比,RCC 患者更容易发生 irAE(aHR 1.61, 95%CI 1.20-2.18)和持续性 eGFR降低(aHR 1.97, 1.24-3.12);两治疗组间的 AKI 发生风险无明显差异(aHR 1.53, 0.97-2.41)。

12个月内有无发生irAE的患者持续性 eGFR降低的累积发生率

在存活1年及以上的患者中,发生非肾性 irAE 与持续性 eGFR降低的风险显著更高相关(aHR 1.71, 95%CI 1.14-2.57)。

总之,AKI 和持续的 eGFR降低在接受 ICI 治疗的泌尿生殖系统癌症患者中很常见。irAE 可能是接受 ICI 治疗的患者肾功能下降的新危险因素

原始出处:

Seethapathy Harish,Street Sarah,Strohbehn Ian et al. Immune-related adverse events and kidney function decline in patients with genitourinary cancers treated with immune checkpoint inhibitors.[J] .Eur J Cancer, 2021, 157: 50-58. https://doi.org/10.1016/j.ejca.2021.07.031

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    2022-03-07 yese
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    2021-10-18 周虎
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    2021-09-14 查查佳佳

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