晚期非小细胞肺癌患者全身抗癌治疗期间肺炎的特征及预后影响
Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer.
作者信息
Fujimoto Daichi, Kato Ryoji, Morimoto Takeshi, Shimizu Ryoko, Sato Yuki, Kogo Mariko, Ito Jiro, Teraoka Shunsuke, Nagata Kazuma, Nakagawa Atsushi, Otsuka Kojiro, Tomii Keisuke
机构信息
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Japan.
出版信息
PLoS One. 2016 Dec 22;11(12):e0168465. doi: 10.1371/journal.pone.0168465. eCollection 2016.
BACKGROUND
Data on characteristics, outcomes, and prognosis of advanced non-small-cell lung cancer (NSCLC) patients who develop pneumonitis during systemic anti-cancer therapy (pneumonitis) are currently lacking.
METHODS
We conducted a retrospective cohort study of 910 consecutive patients diagnosed with advanced NSCLC between January 2004 and January 2014. Of these, 140 patients were excluded because they did not receive systemic anti-cancer therapy at this hospital.
RESULTS
A total of 770 patients were included in the study, of whom 44 (6%) were diagnosed with pneumonitis. The mortality rate of pneumonitis was 36%. The incidence of pneumonitis was independently associated with pre-existing ILD (adjusted odds ratio, 2.99, P = 0.008), and survivors were significantly associated with younger age (P = 0.003) and radiographic non-acute interstitial pneumonia pattern (P = 0.004). In all patients, pneumonitis was identified as an independent predictor of overall survival (OS) (adjusted hazard ratio 1.53, 95% CI, 1.09-2.09, P = 0.015). Performance status was poor in 82% of survivors of pneumonitis; in 62% of survivors, the PS worsened after the pneumonitis improved. Additionally, 54% of survivors received no further systemic anti-cancer therapy after pneumonitis. The median survival time of survivors after pneumonitis was 3.5 months (95% CI, 2.3-7.2 months).
CONCLUSIONS
Our study indicated that 6% of patients with advanced NSCLC developed pneumonitis during systemic anti-cancer therapy. The early mortality rate of pneumonitis is high, and the survival and PS after pneumonitis is extremely poor. Additionally, pneumonitis has an adverse impact on the survival of patients with advanced NSCLC. These data should be considered for the management of pneumonitis, and we recommend that future work focuses on pneumonitis particularly to improve the survival of patients with advanced NSCLC.
背景
目前缺乏关于在全身抗癌治疗期间发生肺炎（肺炎）的晚期非小细胞肺癌（NSCLC）患者的特征、结局和预后的数据。
方法
我们对2004年1月至2014年1月期间连续诊断为晚期NSCLC的910例患者进行了一项回顾性队列研究。其中，140例患者因未在本院接受全身抗癌治疗而被排除。
结果
共有770例患者纳入研究，其中44例（6%）被诊断为肺炎。肺炎的死亡率为36%。肺炎的发生率与既往存在的ILD独立相关（调整后的优势比，2.99，P = 0.008），而幸存者与较年轻的年龄（P = 0.003）和影像学非急性间质性肺炎模式（P = 0.004）显著相关。在所有患者中，肺炎被确定为总生存期（OS）的独立预测因素（调整后的风险比1.53，95%CI，1.09 - 2.09，P = 0.015）。肺炎幸存者中82%的体能状态较差；在62%的幸存者中，肺炎改善后PS恶化。此外，54%的幸存者在肺炎后未接受进一步的全身抗癌治疗。肺炎后幸存者的中位生存时间为3.5个月（95%CI，2.3 - 7.2个月）。
结论
我们的研究表明，6%的晚期NSCLC患者在全身抗癌治疗期间发生肺炎。肺炎的早期死亡率很高，肺炎后的生存和PS极差。此外，肺炎对晚期NSCLC患者的生存有不利影响。在肺炎的管理中应考虑这些数据，我们建议未来的工作尤其关注肺炎，以改善晚期NSCLC患者的生存。
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