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- Title
Body Composition as an Independent Predictive and Prognostic Biomarker in Advanced Urothelial Carcinoma Patients Treated with Immune Checkpoint Inhibitors.
- Authors
MARTINI, DYLAN J.; SHABTO, JULIE M.; GOYAL, SUBIR; YUAN LIU; OLSEN, T. ANDERS; EVANS, SEAN T.; MAGOD, BENJAMIN L.; RAVINDRANATHAN, DEEPAK; BROWN, JACQUELINE T.; YANTORNI, LAUREN; RUSSLER, GRETA ANNE; CAULFIELD, SARAH; GOLDMAN, JAMIE M.; NAZHA, BASSEL; JOSHI, SHREYAS SUBHASH; KISSICK, HAYDN T.; OGAN, KENNETH E.; HARRIS, WAYNE B.; KUCUK, OMER; CARTHON, BRADLEY C.
- Abstract
Background. Several immune checkpoint inhibitors (ICIs) are approved for the treatment of advanced urothelial carcinoma (UC). There are limited biomarkers for ICI-treated patients with UC.We investigated the association between body composition and clinical outcomes in ICI-treated UC patients. Materials and Methods. We conducted a retrospective analysis of 70 ICI-treated patients with advanced UC at Winship Cancer Institute from 2015 to 2020. Baseline computed tomography images within 2 months of ICI initiation were collected at mid-L3 and muscle and fat compartments (subcutaneous, intermuscular, and visceral) were segmented using SliceOMatic v5.0 (TomoVision, Magog, Canada). A prognostic body composition risk score (high: 0-1, intermediate: 2-3, or low-risk: 4) was created based on the β coefficient from the multivariate Cox model (MVA) following best-subset variable selection. Our body composition risk score was skeletal muscle index (SMI) + 2 x attenuated skeletal muscle (SM) mean + visceral fat index (VFI). Concordance statistics (C-statistics) were used to quantify the discriminatory magnitude of the predictivemodel. Results. Most patients (70%) were men and the majority received ICIs in the second- (46%) or third-line (21%) setting. High-risk patients had significantly shorter overall survival (OS; hazard ratio [HR], 6.72; p < .001), progressionfree survival (HR, 5.82; p < .001), and lower chance of clinical benefit (odds ratio [OR], 0.02; p = .003) compared with the low-risk group in MVA. The C-statistics for our body composition risk group and myosteatosis analyses were higher than body mass index for all clinical outcomes. Conclusion. Body composition variables such as SMI, SM mean, and VFI may be prognostic and predictive of clinical outcomes in ICI-treated patients with UC. Larger, prospective studies are warranted to validate this hypothesis-generating data.
- Subjects
BLADDER tumors; BODY composition; DIGITAL image processing; IMMUNE checkpoint inhibitors; SKELETAL muscle; ABDOMINAL adipose tissue; RETROSPECTIVE studies; TREATMENT effectiveness; SURVIVAL analysis (Biometry); TUMOR markers; COMPUTED tomography; BODY mass index; PREDICTION models; IMMUNOTHERAPY; THERAPEUTICS
- Publication
Oncologist, 2021, Vol 26, Issue 12, p1017
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1002/onco.13922