放疗增加肺癌患者住院肺炎风险：一项基于人群的外科队列研究。

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study.

作者信息

Hung Shih-Kai, Chen Yi-Chun, Chiou Wen-Yen, Lai Chun-Liang, Lee Moon-Sing, Lo Yuan-Chen, Chen Liang-Cheng, Huang Li-Wen, Chien Nai-Chuan, Li Szu-Chi, Liu Dai-Wei, Hsu Feng-Chun, Tsai Shiang-Jiun, Chan Michael Wy, Lin Hon-Yi

机构信息

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.

School of Medicine, Tzu Chi University, Hualien, Taiwan.

出版信息

BMJ Open. 2017 Sep 27;7(9):e015022. doi: 10.1136/bmjopen-2016-015022.

DOI:10.1136/bmjopen-2016-015022

PMID:28963281

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5623431/

Abstract

OBJECTIVE

Pulmonary radiotherapy has been reported to increase a risk of pneumonopathy, including pneumonitis and secondary pneumonia, however evidence from population-based studies is lacking. The present study intended to explore whether postoperative irradiation increases occurrence of severe pneumonopathy in lung cancer patients.

DESIGN, SETTING AND PARTICIPANTS: The nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered >99% of Taiwanese) in a real-world setting. From 2000 to 2010, 4335 newly diagnosed lung cancer patients were allocated into two groups: surgery-RT (n=867) and surgery-alone (n=3468). With a ratio of 1:4, propensity score was used to match 11 baseline factors to balance groups.

INTERVENTIONS/EXPOSURES: Irradiation was delivered to bronchial stump and mediastinum according to peer-audited guidelines.

OUTCOMES/MEASURES: Hospitalised pneumonia/pneumonitis-free survival was the primary end point. Risk factors and hazard effects were secondary measures.

RESULTS

Multivariable analysis identified five independent risk factors for hospitalised pneumonopathy: elderly (>65 years), male, irradiation, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Compared with surgery-alone, a higher risk of hospitalised pneumonopathy was found in surgery-RT patients (HR, 2.20; 95% CI, 1.93-2.51; 2-year hospitalised pneumonia/pneumonitis-free survival, 85.2% vs 69.0%; both p<0.0001), especially in elderly males with COPD and CKD (HR, 13.74; 95% CI, 6.61-28.53; p<0.0001). Unexpectedly, we observed a higher risk of hospitalised pneumonopathy in younger irradiated-CKD patients (HR, 13.07; 95% CI, 5.71-29.94; p<0.0001) than that of elderly irradiated-CKD patients (HR, 4.82; 95% CI, 2.88-8.08; p<0.0001).

CONCLUSIONS

A high risk of hospitalised pneumonopathy is observed in irradiated patients, especially in elderly males with COPD and CKD. For these patients, close clinical surveillance and aggressive pneumonia/pneumonitis prevention should be considered. Further investigations are required to define underlying biological mechanisms, especially for younger CKD patients.

摘要

目的

据报道，肺部放疗会增加发生肺部疾病的风险，包括肺炎和继发性肺炎，然而基于人群的研究证据尚不足。本研究旨在探讨术后放疗是否会增加肺癌患者发生严重肺部疾病的几率。

设计、背景与参与者：这项全国性基于人群的研究在实际环境中分析了台湾国民健康保险研究数据库（覆盖了超过99%的台湾人）。2000年至2010年，4335例新诊断的肺癌患者被分为两组：手术加放疗组（n = 867）和单纯手术组（n = 3468）。采用倾向评分以1:4的比例匹配11个基线因素来平衡两组。

干预措施/暴露因素：根据同行审核的指南对支气管残端和纵隔进行放疗。

结果/测量指标：住院期间无肺炎/肺炎生存情况是主要终点。危险因素和风险效应是次要测量指标。

结果

多变量分析确定了住院肺部疾病的五个独立危险因素：年龄大于65岁、男性、放疗、慢性阻塞性肺疾病（COPD）和慢性肾病（CKD）。与单纯手术组相比，手术加放疗组患者发生住院肺部疾病的风险更高（风险比[HR]，2.20；95%置信区间[CI]，1.93 - 2.51；2年无住院肺炎/肺炎生存率，85.2%对69.0%；p均<0.0001），尤其是患有COPD和CKD的老年男性（HR，13.74；95% CI，6.61 - 28.53；p<0.0001）。出乎意料的是，我们观察到接受放疗的年轻CKD患者发生住院肺部疾病的风险（HR，13.07；95% CI，5.71 - 29.94；p<0.0001）高于接受放疗的老年CKD患者（HR，4.82；95% CI，2.88 - 8.08；p<0.0001）。