Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA.
Department of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, USA.
Abdom Radiol (NY). 2020 Oct;45(10):3028-3035. doi: 10.1007/s00261-019-02334-3.
To determine the frequency, imaging, and clinical manifestations of immune checkpoint inhibitor (ICI)-related colitis in cancer patients on monotherapy or combination therapy.
The electronic medical records of 1044 cancer patients who received ICIs were retrospectively reviewed to identify 48 patients who had a clinical diagnosis of immune-related colitis. Imaging studies were reviewed to identify patients with imaging manifestations of colitis. Demographic data, type of ICIs, symptoms, presence of other immune-related adverse events (irAEs), and management were recorded.
There was imaging evidence of immune-related colitis in 34 patients (24 men; median age: 63.5 years). The median time to onset of colitis was 75 days (IQR 25-75, 49.5-216 days) in patients receiving monotherapy (group 1) and 78 days (IQR 25-75, 44.3-99.5 days) in patients undergoing combination therapy (group 2) following start of ICI. Symptoms included diarrhea (91.1% [31 of 34]), nausea/vomiting (52.9% [18 of 34]), and abdominal pain (52.9% [18 of 34]). The most common imaging findings were bowel wall thickening (97% [33 of 34]) and fluid-filled colon (82.3% [28 of 34]). Colitis was diffuse in 21 of 34 (61.8%) patients. Imaging manifestations did not differ between the two groups (p > 0.05). Steroids and antibiotics were used to treat colitis in 29 of 34 (85.2%) and 13 of 34 (38.2%) patients, respectively. No patients in group 1 experienced concurrent irAEs, but 5 of 18 (27.8%) of patients in group 2 had other irAEs (p = 0.046).
Immune-related colitis occurred in 3.3% of patients receiving ICIs with bowel wall thickening, fluid-filled colon and pancolitis being the most common imaging manifestations. Imaging manifestations did not differ between patients receiving monotherapy or combination therapy. However, concurrent irAEs were significantly observed in patients undergoing combination therapy.
确定单药或联合治疗的癌症患者中免疫检查点抑制剂（ICI）相关结肠炎的频率、影像学表现和临床表现。
回顾性分析 1044 例接受 ICI 治疗的癌症患者的电子病历，以确定 48 例临床诊断为免疫相关性结肠炎的患者。对影像学检查进行回顾性分析，以确定有结肠炎影像学表现的患者。记录患者的人口统计学数据、ICI 类型、症状、其他免疫相关不良事件（irAE）的存在情况以及治疗方法。
34 例患者（24 例男性；中位年龄：63.5 岁）有免疫相关性结肠炎的影像学证据。在接受单药治疗的患者（第 1 组）中，结肠炎的中位发病时间为 75 天（IQR 25-75，49.5-216 天），在接受联合治疗的患者（第 2 组）中为 78 天（IQR 25-75，44.3-99.5 天）。症状包括腹泻（91.1%[31/34]）、恶心/呕吐（52.9%[18/34]）和腹痛（52.9%[18/34]）。最常见的影像学表现为肠壁增厚（97%[33/34]）和充满液体的结肠（82.3%[28/34]）。21 例患者结肠炎为弥漫性（61.8%）。两组之间的影像学表现无差异（p>0.05）。29 例患者（85.2%）接受皮质类固醇治疗，13 例患者（38.2%）接受抗生素治疗。第 1 组无患者出现同时发生的 irAE，但第 2 组有 5 例（27.8%）患者出现其他 irAE（p=0.046）。
ICI 治疗的患者中有 3.3%发生免疫相关性结肠炎，肠壁增厚、充满液体的结肠和全结肠炎是最常见的影像学表现。单药或联合治疗的患者影像学表现无差异。然而，联合治疗的患者明显观察到同时发生的 irAE。
