Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan.
Respiratory Center, Otsuki Municipal Central Hospital, Yamanashi, Japan.
Thorac Cancer. 2021 Mar;12(5):667-675. doi: 10.1111/1759-7714.13792. Epub 2021 Jan 21.
Interstitial lung disease (ILD) in patients with non-small cell lung cancer (NSCLC) worsens the prognosis for overall survival (OS) due to chemotherapy-triggered acute exacerbation (AE)-ILD. The Glasgow Prognostic Score (GPS), which is based on serum C-reactive protein and albumin levels, has been suggested as a reliable prognostic tool for mortality in cancer patients, including NSCLC. In this study, we investigated whether GPS is a predictor for chemotherapy-triggered AE-ILD and the prognosis in patients with NSCLC and pre-existing ILD.
We conducted a retrospective review on 56 NSCLC and ILD patients at our hospital who received platinum agent-based treatment as first-line chemotherapy between June 2010 and May 2019. We categorized these patients according to their GPS (0-2) and compared the incidence of chemotherapy-triggered AE-ILD and OS.
The GPS 0, 1, and 2 groups included 31, 16, and nine patients, respectively, out of 56. A total of 12 (21.4%) patients showed chemotherapy-triggered AE-ILD. The median OS was at 11.5 months (95% confidence interval: 8.0-15.1). The incidence of chemotherapy-triggered AE-ILD within the first year of chemotherapy in the GPS 0, 1, and 2 groups was three (9.6%), four (25.0%), and five (55.5%), and the median OS time was 16.9, 9.8 and 7.6 months, respectively. Univariate and multivariate analyses indicated that only GPS 2 could predict both chemotherapy-triggered AE-ILD and OS (P < 0.05).
GPS assessment of patients with NSCLC and pre-existing ILD is a valuable prognostic tool for predicting chemotherapy-triggered AE-ILD and OS.
SIGNIFICANT FINDINGS OF THE STUDY: We found that GPS 2 was an independent risk factor for chemotherapy-triggered AE-ILD and prognosis in patients with ILD associated with NSCLC.
GPS may potentially enable the discrimination of patients tolerant of chemotherapy from those at an increased risk of AE-ILD and predict the prognosis in patients with NSCLC and ILD receiving chemotherapy.
非小细胞肺癌（NSCLC）患者的间质性肺病（ILD）会因化疗引发的急性加重（AE）-ILD 而导致总生存（OS）预后恶化。基于血清 C 反应蛋白和白蛋白水平的格拉斯哥预后评分（GPS）已被证明是癌症患者，包括 NSCLC 患者死亡率的可靠预后工具。在这项研究中，我们研究了 GPS 是否可预测 NSCLC 合并预先存在的 ILD 患者的化疗引发的 AE-ILD 和预后。
我们对 2010 年 6 月至 2019 年 5 月在我院接受铂类药物为基础的一线化疗的 56 例 NSCLC 和 ILD 患者进行了回顾性研究。我们根据 GPS（0-2）对这些患者进行分类，并比较了化疗引发的 AE-ILD 和 OS 的发生率。
56 例患者中，GPS 0、1 和 2 组分别有 31、16 和 9 例。共有 12 例（21.4%）患者出现化疗引发的 AE-ILD。中位 OS 为 11.5 个月（95%置信区间：8.0-15.1）。GPS 0、1 和 2 组化疗后第一年的化疗引发 AE-ILD 发生率分别为 3（9.6%）、4（25.0%）和 5（55.5%），中位 OS 时间分别为 16.9、9.8 和 7.6 个月。单因素和多因素分析表明，只有 GPS 2 可预测化疗引发的 AE-ILD 和 OS（P<0.05）。
对 NSCLC 和预先存在的 ILD 患者进行 GPS 评估是预测化疗引发的 AE-ILD 和 OS 的有价值的预后工具。
本研究的重要发现：我们发现 GPS 2 是 ILD 相关 NSCLC 患者化疗引发的 AE-ILD 和预后的独立危险因素。
GPS 可能能够区分能够耐受化疗的患者和 AE-ILD 风险增加的患者，并预测接受化疗的 NSCLC 和 ILD 患者的预后。
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