The Impact Of Body Mass Index On The Efficacy And Safety Of Immunotherapy For Esophageal Squamous Cell Carcinoma

Objective By observing the effect of baseline Body mass index(Body mass index,BMI)on the efficacy and safety of immunotherapy combined with chemotherapy in the first-line treatment of locally advanced and advanced esophageal squamous cell carcinoma,this paper aims to explore the effects of obesity and overweight on immunotherapy for esophageal squamous cell carcinoma,and to explore the biomarkers of esophageal squamous cell carcinoma immunotherapy.Methods A total of 56 patients with locally advanced or recurrent metastatic advanced esophageal squamous cell carcinoma admitted to the First Affiliated Hospital of Dalian Medical University from January 1,2020 to December 31,2022 were restrospectively observed.They were divided into 2 groups according to the different BMI of the patients,non-overweight group(BMI<23 kg/m2,n=31)and overweight group(BMI≥23 kg/m2,n=25).Clinical data such as baseline clinical features,medication regimen,efficacy,adverse reactions and prognosis were collected.SPSS 25.0 and Graph Pad Prism 9.5 were used for statistical analysis and survival curves were drawn.Results1.Short-term efficacy:The objective response rate(ORR)and the disease control rate(DCR)of the non-overweight group were respectively 29%and 74.2%,of which the overweight group were respectively 56%and 80%.In terms of DCR,the overweight group was higher than the non-overweight group,but the difference was not statistically significant(P=0.609).In terms of ORR of objective response rate,P=0.041<0.05,indicating that the difference was statistically significant,and it could be considered that supercombination had a higher ORR.2.Survival Analysis:The median progression-free survival(mPFS)in the overweight group was 7.8 months(95%CI 7.1～8.5 months),which was significantly higher than that of the non-overweight group 6 months(95%CI 4.5～7.5 months),the difference was statistically significant(P=0.04).The median overall survival time(m OS)in the overweight group was 15.9 months(95%CI 13.0～18.8 months),significantly higher than the non-overweight group 12 months(95%CI 9.5～15.7months),the difference was statistically significant(P=0.024)。3.Analysis of prognostic factors:Kaplan-Meier univariate analysis showed that ECOG score,degree of pathological differentiation and BMI were the influencing factors of PFS and OS(P<0.1),and the median PFS and OS of ECOG score 0,high/medium tumor differentiation and BMI≥23.0 kg/m2 were significantly prolonged.The difference was statistically significant(P<0.05).Further multivariate COX regression analysis showed that ECOG score,degree of pathological differentiation and BMI were all independent factors affecting PFS and OS,and the difference was statistically significant(P<0.05).4.Adverse reactions:The main adverse reactions were grade 1-2.The incidence of immune-related adverse events(ir AEs),such as skin mucosal reaction,endocrine damage(hyperthyroidism,hypothyroidism,adrenal insufficiency,etc.),immune hepatitis and immune pneumonia were higher than those of ir AEs.The difference of reaction of skin mucous membrane and endocrine damage was statistically significant(skin mucous membrane reaction:χ~2=4.310,P=0.038;Endocrine damage:χ~2=3.989,P=0.046).The incidence of nausea and vomiting,neutropenia,thrombocytopenia and abnormal liver and kidney function were lower than those of non-overweight group,but the difference was not statistically significant.Conclusion1.In patients with locally advanced/advanced esophageal squamous cell carcinoma receiving first-line immunotherapy combined with chemotherapy,overweight and obese patients had a better survival benefit,and BMI may have the potential to be a predictor of efficacy of immunotherapy for esophageal cancer;2.Overweight and obese patients with locally advanced/advanced esophageal squamous cell carcinoma had a higher incidence of immunotherapy-related adverse events,among which the difference between mucocutaneous reaction and endocrine injury was statistically significant;3.ECOG score,degree of pathological differentiation,and BMI can be independent prognostic factors for efficacy of first-line immunotherapy in patients with locally advanced/advanced esophageal squamous cell carcinoma.