肾癌免疫评分系统预测转移性肾细胞癌二线靶向治疗临床疗效的初步探索

Preliminary exploration of the metastatic renal cell carcinoma immune scoring for predicting the clinical efficacy of second-line targeted therapy for metastatic renal cell carcinoma

目的验证免疫评分系统在预测转移性肾细胞癌二线治疗临床疗效中的效果。方法回顾性分析2010年至2021年复旦大学附属中山医院接受一线靶向治疗后出现疾病进展(或药物不耐受)的60例晚期转移性肾细胞癌患者的临床资料。根据二线治疗药物,将患者分为依维莫司组(29例)及阿昔替尼组(31例)。比较两组的临床疗效。利用课题组以往建立的免疫评分系统,将患者分为低危组(27例)、中危组(20例)、高危组(13例)。比较三组的临床疗效。比较免疫评分系统与国际转移性肾细胞癌联合数据库评分(IMDC)对治疗效果的预测效能。结果所有患者最长随访时间为84.2个月。阿昔替尼组的无进展生存期(PFS)优于依维莫司组(P=0.019)。阿昔替尼组的总生存期(OS)优于依维莫司组(P=0.029)。低危组患者的PFS优于高危组(P<0.001)。低危组患者的OS优于高危组(P<0.001)。绘制受试者工作特征(ROC)曲线比较免疫评分系统及IMDC评分系统,结果显示,免疫评分系统的ROC曲线下面积(AUC)优于IMDC风险模型(0.822 vs.0.620)。结论作为转移性肾细胞癌的二线治疗,依维莫司的疗效可能优于阿昔替尼。联合免疫学指标及IMDC评分建立的免疫评分模型可用于预测转移性肾细胞癌二线治疗的效果。

Objective To structure immunoscore system for predicting clinical efficacy of the second-line treatment in metastatic renal cell carcinoma(mRCC).Methods The clinical data of 60 patients with advanced metastatic renal cell carcinoma who developed disease progression(or drug intolerance)after receiving first-line targeted therapy in Zhongshan Hospital Affiliated to Fudan Universityfrom 2010 to 2021 were retrospectively analyzed.The patients were divided into everolimus group(29 cases)and axitinib group(31 cases)according to different second-line treatment.The clinical efficacy were compared.According to the immune score established in the past,the patients were divided into low risk group(27 cases),medium risk group(20 cases)and high-risk group(13 cases).The clinical efficacy of the three groups were compared,and thereceiver oprating characteristic(ROC)curve was analyzed with the International mRCC Database Consortium(IMDC)risk model.Results The longest follow-up period for all patients was 84.2 months.The PFS of the axitinib group was superior to that of the everolimus group(P=0.019).The OS of the axitinib group was also superior to that of the everolimus group(P=0.029).The progression free survival(PFS)of the low-risk group was superior to that of the high-risk group(P<0.001).The overall survival(OS)of the low-risk group was also superior to that of the high-risk group(P<0.001).ROC curve comparing immune scoring system and IMDC scoring system showed that AUC value of immune scoring system was better than IMDC risk model(0.822 vs.0.620).Conclusions Everolimus as a second-line treatment for mRCC,it may be more effective than acitinib.The immune score model can be used to predict the effect of second-line treatment of mRCC.