背景:尽管原发性葡萄膜黑色素瘤(UM)的治疗有所改善,转移性疾病患者的生存率仍然很低.
方法:对耶鲁(初始队列)和MemorialSloanKettering(验证队列)的转移性UM患者进行回顾性回顾。Cox比例风险回归用于确定与总生存率相关的基线因素。包括性,东部肿瘤协作组(ECOG)绩效状态量表,实验室测量,转移部位,以及使用抗CTLA-4和抗PD-1疗法。使用Kaplan-Meier分析分析总生存期的差异。
结果:共确定了89例转移性UM患者;在初始和验证队列中,分别为71例和18例,分别。在最初的队列中,中位随访时间为19.8个月(范围,2-127个月),中位总生存期为21.8个月(95%CI,16.6-31.3)。女性性别,抗CTLA-4和抗PD-1治疗与更好的生存结果相关,调整后的死亡风险比(HR)为0.40(95%CI,0.20-0.78),0.44(0.20-0.97),和0.42(0.22-0.84),分别,而肝转移和ECOG评分≥1(每1U/L)的发展与较差的生存结果相关,HR为2.86(1.28-7.13)和2.84(1.29-6.09),分别。在初始队列和验证队列中,在调整性别和ECOG评分后,使用免疫检查点抑制剂与总生存期改善相关,死亡HR为0.22(0.08-0.56)和0.04(0.002-0.26),分别。
结论:仅肝外转移的发展,ECOG为0,免疫检查点治疗,女性和女性均与死亡风险降低2倍以上相关.
结论:转移性葡萄膜黑色素瘤患者面临有限的治疗选择和低生存率。这项回顾性分析的结果表明,免疫检查点抑制剂,如抗CTLA-4和抗PD-1治疗,与生存结局改善相关。因素如仅肝外转移,更好的基准性能状态,女性导致死亡风险降低2倍以上。这些发现强调了免疫治疗治疗转移性葡萄膜黑色素瘤的潜力。
Despite improvements in the treatment of primary uveal melanoma (UM), patients with metastatic disease continue to exhibit poor survival.
A retrospective review of metastatic UM patients at Yale (initial cohort) and Memorial Sloan Kettering (validation cohort) was conducted. Cox proportional hazards regression was used to determine baseline factors that are associated with overall survival, including sex, Eastern Cooperative Oncology Group (ECOG) Performance Status Scale, laboratory measurements, metastasis location, and use of anti-CTLA-4 and anti-PD-1 therapies. Differences in overall survival were analyzed using Kaplan-Meier analysis.
A total of 89 patients with metastatic UM were identified; 71 and 18, in the initial and validation cohorts, respectively. In the initial cohort, median follow-up was 19.8 months (range, 2-127 months) and median overall survival was 21.8 months (95% CI, 16.6-31.3). Female sex, anti-CTLA-4, and anti-PD-1 therapy were associated with better survival outcomes with adjusted death hazard ratios (HRs) of 0.40 (95% CI, 0.20-0.78), 0.44 (0.20-0.97), and 0.42 (0.22-0.84), respectively, whereas development of hepatic metastases and ECOG score ≥1 (per 1 U/L) were associated with worse survival outcomes with HRs of 2.86 (1.28-7.13) and 2.84 (1.29-6.09), respectively. In both the initial and validation cohorts, use of immune checkpoint inhibitors was associated with improved overall survival after adjusting for sex and ECOG score, with death HRs of 0.22 (0.08-0.56) and 0.04 (0.002-0.26), respectively.
Development of extrahepatic-only metastases, ECOG of 0, immune checkpoint therapy, and female sex were each associated with more than 2-fold reductions in risk of death.
Metastatic uveal melanoma patients face limited treatment options and poor survival rates. Results from this retrospective analysis indicate that immune checkpoint inhibitors, such as anti-CTLA-4 and anti-PD-1 therapies, were associated with improved survival outcomes. Factors such as extrahepatic-only metastases, better baseline performance status, and female sex contributed to a more than 2-fold reduction in death risk. These findings highlight the potential of immunotherapy in treating metastatic uveal melanoma.