目的:本研究的目的是确定免疫相关内分泌疾病发展的预测和危险因素,并分析我们人群中免疫相关内分泌疾病的发生率和特征设计:回顾性,2018年1月至2019年12月,在GregorioMarañón医院开展了单中心队列研究。
方法:共纳入163例患者。在2018年1月和2019年12月,我们在一般大学医院GregorioMarañón的肿瘤内科治疗接受ICI治疗的患者,马德里的一家三级保健公立医院,作为观察的一部分,回顾性,单中心队列研究。
结果:19.5%的患者(n=32)被诊断为内分泌病。内分泌疾病发生率最高的肿瘤是非小细胞肺癌(25,9%),肾细胞癌(25%)和肝癌(20%)。在发生内分泌疾病的32名患者中,18.8%,19,13%,和21,28%分别接受抗CTLA-4,抗PD-1和抗PDL-1。甲状腺功能障碍是最常见的内分泌疾病(12,8%)。抗TPO和抗TG抗体阴性的患者发生G1甲状腺功能减退的比例高于G2甲状腺功能减退的抗体阳性的患者。甲状腺毒性的初始阶段的存在与更严重的程度无关。我们观察到发生甲状腺功能障碍的患者的无进展生存期更长。
结论:预先存在的抗体与内分泌疾病独立相关。此外,我们的研究让我们得出结论,甲状腺自身抗体的存在可能与其严重程度有关.重要的是在免疫疗法开始之前确定抗甲状腺抗体作为甲状腺功能障碍的危险因素,这反过来又是一个预后标志。
OBJECTIVE: The purpose of this study was to identify predictive and risk factors for the development of immune-related endocrinopathies and to analyze the incidence and characteristics of immune-related endocrinopathies in our population Design: A retrospective, single-centre cohort carried out at Gregorio Marañón Hospital between January 2018 -December 2019.
METHODS: A total of 163 patients were enrolled. In January 2018 and December 2019, we treated patients who underwent ICI treatment in the Medical Oncology Department of General University Hospital Gregorio Marañón, a tertiary care public hospital in Madrid, as part of an observational, retrospective, single-center cohort study.
RESULTS: Endocrinopathies were diagnosed in 19.5% of the patients (n=32). The tumours with the highest incidence of endocrinopathies were non-small cell lung cancer (25,9%), kidney cell cancer (25%) and hepatocarcinoma (20%). Among the 32 patients who developed endocrinopathy, 18,8%, 19,13%, and 21,28% received anti-CTLA-4, anti-PD-1 and anti-PDL-1, respectively. Thyroid dysfunction was the most frequent endocrinopathy (12,8%). A higher percentage of patients with negative antiTPO and antiTG antibodies developed G1 hypothyroidism compared to patients with positive antibodies who developed a higher proportion of G2 hypothyroidism. The presence of an initial phase of thyrotoxicity was not related to greater severity. We observed longer progression-free survival in patients who developed thyroid dysfunction.
CONCLUSIONS: Pre-existing antibodies were independently associated with endocrinopathies. Moreover, our study let us conclude that the presence of thyroid autoantibodies may be related to its severity. It is important to determine anti-thyroid antibodies prior to the start of immunotherapy as a risk factor for thyroid dysfunction, which in turn is a prognostic marker.