免疫检查点抑制剂治疗晚期肺外癌症患者肺炎的风险因素。
Risk factors for pneumonitis in advanced extrapulmonary cancer patients treated with immune checkpoint inhibitors.
机构信息
Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan.
Department of Radiology, Shiga University of Medical Science, Otsu, Japan.
出版信息
BMC Cancer. 2022 May 16;22(1):551. doi: 10.1186/s12885-022-09642-w.
BACKGROUND
Immune-mediated pneumonitis has a high mortality rate; however, information regarding the related risk factors remains limited. This study aimed to analyze risk factors for pneumonitis, including smoking and lung metastasis (LM), in patients with extrapulmonary primary tumors.
METHODS
Data of 110 patients treated with immune checkpoint inhibitors (ICIs) (nivolumab/pembrolizumab) for treating extrapulmonary primary tumors at the Shiga University of Medical Science Hospital between January 2015 and December 2019 were retrospectively collected. The association between the onset of pneumonitis and treatment-related factors was analyzed by logistic regression. The severity of pneumonitis was graded according to the Common Terminology Criteria for Adverse Events version 5.0. Risk factors, such as the absence or presence of interstitial lung disease (ILD) and LM, or other clinical factors, including smoking status before ICI administration, were analyzed.
RESULTS
Multivariate analyses indicated that the amount of smoking was significantly associated with an increase in the development of all-grade pneumonitis types (odds ratio (OR) = 20.33, 95% confidence interval (CI) = 20.03-20.66; p = 0.029). LM and ILD were significantly related to an increase in the development of symptomatic pneumonitis (≥ Grade 2) (OR = 10.08, 95% CI = 1.69-199.81; p = 0.076, and OR = 6.76, 95% CI = 1.13-40.63; p = 0.037, respectively).
CONCLUSIONS
Pre-screening for ILD and LM and recognizing patients' smoking history is important for determining the risk of ICI-induced pneumonitis and allowing safe ICI administration.
背景
免疫介导性肺炎的死亡率很高；然而，关于相关危险因素的信息仍然有限。本研究旨在分析肺外原发性肿瘤患者发生肺炎的危险因素，包括吸烟和肺转移（LM）。
方法
回顾性收集了 2015 年 1 月至 2019 年 12 月在滋贺医科大学医院接受免疫检查点抑制剂（nivolumab/pembrolizumab）治疗肺外原发性肿瘤的 110 例患者的数据。通过 logistic 回归分析治疗相关因素与肺炎发病之间的关系。根据通用不良事件术语标准 5.0 对肺炎的严重程度进行分级。分析了有无间质性肺病（ILD）和 LM 或其他临床因素（包括免疫检查点抑制剂治疗前的吸烟状况）等危险因素。
结果
多变量分析表明，吸烟量与所有级别肺炎类型的发展显著相关（优势比（OR）=20.33，95%置信区间（CI）=20.03-20.66；p=0.029）。LM 和 ILD 与症状性肺炎（≥2 级）的发展显著相关（OR=10.08，95%CI=1.69-199.81；p=0.076，和 OR=6.76，95%CI=1.13-40.63；p=0.037）。
结论
对 ILD 和 LM 进行预先筛查，并识别患者的吸烟史，对于确定 ICI 诱导性肺炎的风险和允许安全使用 ICI 非常重要。
Zotero 插件