Liu JY, Gao DL, Cao X. Risk factors and diagnostic biomarkers for asymptomatic immune checkpoint inhibitor-related myocarditis in patients with esophageal cancer after immunotherapy. World J Gastroenterol 2025; 31(26): 106509 [DOI: 10.3748/wjg.v31.i26.106509]
Corresponding Author of This Article
Xin Cao, MM, Doctor, Department of Radiotherapy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Employee New Village, Xinghualing District, Taiyuan 030001, Shanxi Province, China. cx18835129589@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 14, 2025; 31(26): 106509 Published online Jul 14, 2025. doi: 10.3748/wjg.v31.i26.106509
Risk factors and diagnostic biomarkers for asymptomatic immune checkpoint inhibitor-related myocarditis in patients with esophageal cancer after immunotherapy
Jing-Yu Liu, Dong-Lai Gao, Xin Cao
Jing-Yu Liu, Dong-Lai Gao, Department of Cardiology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Xin Cao, Department of Radiotherapy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Liu JY, Gao DL and Cao X designed the experiments, collected and collated the clinical data, performed statistical analysis, and wrote the original manuscript and final manuscript; Gao DL performed postoperative follow-up and recorded the data; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Shanxi Province Cancer Hospital (No. KY2024126).
Informed consent statement: The Ethics Committee agreed to waive informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Cao, MM, Doctor, Department of Radiotherapy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Employee New Village, Xinghualing District, Taiyuan 030001, Shanxi Province, China. cx18835129589@163.com
Received: March 5, 2025 Revised: April 29, 2025 Accepted: June 18, 2025 Published online: July 14, 2025 Processing time: 128 Days and 0.7 Hours
Abstract
BACKGROUND
Esophageal cancer is a serious global health concern with poor prognosis in advanced stages. Immune checkpoint inhibitors (ICIs) have shown promise in enhancing survival, but they are associated with immune-related adverse events, including potentially life-threatening myocarditis. Moreover, ICI-induced myocarditis can be asymptomatic, necessitating early diagnosis. Specific risk factors and biomarkers for esophageal cancer remain poorly characterized.
AIM
To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers.
METHODS
A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024.
RESULTS
Older age, male gender, and elevated creatine kinase isoenzymes (CK-MB) and CK levels were found to be significant risk factors for asymptomatic myocarditis. The myocarditis occurrence group had higher CK-MB (3.05 ng/mL vs 5.02 ng/mL; P < 0.001) and CK levels (187.29 U/L vs 212.25 U/L; P = 0.005), and the predictive value of age, gender, CK, and CK-MB was low [are under the receiver operating characteristic curve (AUC) = 0.579-0.608]. However, their combination in a predictive model showed improved diagnostic capability, with an AUC of 0.808.
CONCLUSION
Age, gender, and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer. The integration of these factors into a predictive model enhances early diagnosis, facilitating personalized risk management.
Core Tip: This study investigates the determinants of immune checkpoint inhibitor (ICI)-associated asymptomatic myocarditis in patients with esophageal cancer. We identified age, gender, and elevated cardiac biomarker levels as significant risk factors for ICI-associated myocarditis. Elevated creatine kinase isoenzymes (CK-MB) and CK levels, along with prolonged QRS duration, were early biomarkers for assessing this condition. Integration of these factors into predictive models may enhance early diagnosis and personalized risk management, improving outcomes for patients receiving immunotherapy.
