Department of Pulmonology, Semmelweis University, Budapest, Hungary.
Thorac Cancer. 2019 Sep;10(9):1819-1826. doi: 10.1111/1759-7714.13153. Epub 2019 Jul 17.
Pulmonary malignancy is one of the most frequent and fatal cancers in older patients. As data on lower respiratory tract infection (LRTI) and the outcome of lung cancer are scarce, our objective was to determine the impact of LRTI on therapeutic possibilities and one-year mortality.
Patients undergoing bronchoscopy in 2017 who had bronchial microbial sampling at the time of the lung cancer diagnosis (n = 143) were included. Group 1 (LRTI+) included patients with confirmed infection (n = 74) while Group 2 (LRTI-) included patients without infection (n = 69). Clinical characteristics, pathogen profile and one-year survival were analyzed.
Age, gender, TNM stage, histology type, comorbidities or underlying lung disease did not differ among groups. The most common LRTI pathogens included aerobic (n = 49), anaerobic (n = 14) and fungal (n = 26) infections. Chemo/immune/target therapy alone, or in combination with radiotherapy were significantly less frequently used, whilst palliative care was more common in Group 1 (LRTI+). Multiple pathogen LRTI patients were significantly older, less frequently diagnosed with adenocarcinoma and had worse performance status compared to solitary pathogen LRTI patients. One-year median survival was 274 days (235 vs. 305 days Group 1 vs. Group 2). Risk factors for increased one-year mortality included performance status ≥2 (OR 30.00, CI 95% 5.23-313.00), performance status 1 (OR 11.87, CI 95% 4.12-33.78), male gender (OR 4.04, CI 2.03-8.04), LRTI with multiple pathogens (OR 2.72, CI 1.01-6.81) and nonadenocarcinoma histology (OR 2.26, CI 1.15-4.56).
LRTIs in lung cancer patients, especially multiple pathogen infections, are associated with less oncotherapeutic possibilities and significant risk for lower one-year median survival.
肺部恶性肿瘤是老年患者中最常见和最致命的癌症之一。由于关于下呼吸道感染（LRTI）和肺癌预后的数据很少，我们的目的是确定 LRTI 对治疗可能性和一年死亡率的影响。
纳入了 2017 年接受支气管镜检查且在肺癌诊断时进行支气管微生物采样的患者（n=143）。第 1 组（LRTI+）包括确诊感染的患者（n=74），第 2 组（LRTI-）包括无感染的患者（n=69）。分析了临床特征、病原体谱和一年生存率。
年龄、性别、TNM 分期、组织学类型、合并症或基础肺部疾病在两组之间无差异。最常见的 LRTI 病原体包括需氧菌（n=49）、厌氧菌（n=14）和真菌（n=26）感染。单独或联合放疗的化疗/免疫/靶向治疗明显较少，而第 1 组（LRTI+）姑息治疗更为常见。多病原体 LRTI 患者年龄较大，较少被诊断为腺癌，且表现状态较单病原体 LRTI 患者差。中位一年生存率为 274 天（235 天与 305 天，第 1 组与第 2 组）。增加一年死亡率的危险因素包括表现状态≥2（OR 30.00，95%CI 5.23-313.00）、表现状态 1（OR 11.87，95%CI 4.12-33.78）、男性（OR 4.04，95%CI 2.03-8.04）、多病原体 LRTI（OR 2.72，95%CI 1.01-6.81）和非腺癌组织学（OR 2.26，95%CI 1.15-4.56）。
肺癌患者的 LRTIs，尤其是多病原体感染，与较少的肿瘤治疗可能性和显著降低的一年中位生存率相关。
