甲状腺功能在头颈部鳞状细胞癌（R/M HNSCC）的复发/转移中常常受损。在接受pembrolizumab治疗的患者中，免疫相关甲状腺不良事件（irAEs）是常见的。然而，基线和治疗中甲状腺功能障碍的预后意义目前尚不清楚。本研究纳入了2016年至2022年接受pembrolizumab治疗R/M HNSCC的95名患者。评估了基线甲状腺状况，包括血清激素水平，以及irAEs。进行了单变量和多变量Cox回归分析来评估总生存期（OS）和无进展生存期（PFS）。此外，还检查了根据预后组的最佳总体反应。 低fT3（HR: 2.52, p = 0.006）、免疫相关甲状腺机能亢进（HR: 0.11, p = 0.038）、ECOG状态≥2（HR: 3.72, p = 0.002）和铂类耐药性疾病（HR: 3.29, p = 0.020）与OS独立相关。此外，免疫相关甲状腺机能亢进与更长的PFS（HR: 0.13, p = 0.007）、更高的客观缓解率（83% vs. 31%, p = 0.018）和更高的疾病控制率（100% vs. 43%, p = 0.008）相关。40%的可测量甲状腺irAEs病例中的甲状腺相关自身抗体升高。在16个甲状腺irAEs中，有15个发生在fT3高于正常下限的患者中。 低fT3与较差的OS相关。免疫相关甲状腺机能亢进与改善的OS和PFS相关。在接受pembrolizumab治疗的R/M HNSCC患者中，基线fT3评估和密切的治疗监测血清甲状腺水平可能对风险分层有价值。版权所有 © 2023. Elsevier B.V.出版

Thyroid function is frequently impaired in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). In patients treated with pembrolizumab, immune-related adverse events (irAEs) of the thyroid are common. However, the prognostic significance of baseline and on-treatment thyroid dysfunction is currently unclear.This study included 95 patients who received pembrolizumab for R/M HNSCC between 2016 and 2022. Baseline thyroid status, according to serum hormone levels, and irAEs were assessed. Univariable and multivariable Cox regression analyses were performed for overall survival (OS) and progression-free survival (PFS). Furthermore, the best overall response according to the prognostic groups was examined.Low fT3 (HR: 2.52, p = 0.006), immune-related hyperthyroidism (HR: 0.11, p = 0.038), ECOG performance status ≥2 (HR: 3.72, p = 0.002), and platinum-refractory disease (HR: 3.29, p = 0.020) were independently associated with OS. Furthermore, immune-related hyperthyroidism was associated with longer PFS (HR: 0.13, p = 0.007), a higher objective response rate (83% vs. 31%, p = 0.018), and a higher disease control rate (100% vs. 43%, p = 0.008). Thyroid-related autoantibodies were elevated in 40% of thyroid irAEs cases with available measurements. Out of 16 thyroid irAEs, 15 occurred in patients with fT3 above the lower limit of normal.Low fT3 was associated with worse OS. Immune-related hyperthyroidism was correlated with both improved OS and PFS. Baseline fT3 assessment and close on-treatment monitoring of serum thyroid levels may be valuable for risk stratification in R/M HNSCC patients receiving pembrolizumab.Copyright © 2023. Published by Elsevier B.V.