免疫治疗期间易发生血栓栓塞的转移性肺癌患者特征。

Profile of metastatic lung cancer patients susceptible to development of thromboembolism during immunotherapy.

作者信息

Endo Satoshi, Honda Takayuki, Kawahara Tatsuo, Sakakibara Rie, Mitsumura Takahiro, Okamoto Tsukasa, Miyazaki Yasunari

机构信息

Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

Division of Respiratory Medicine, Shuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama 344-0035, Japan.

出版信息

Cancer Treat Res Commun. 2022;31:100547. doi: 10.1016/j.ctarc.2022.100547. Epub 2022 Mar 10.

DOI:10.1016/j.ctarc.2022.100547

PMID:35290865

Abstract

BACKGROUND

Thromboembolism (TE) is a serious complication in lung cancer patients; however, risk factors for developing TE during treatment with immuno-oncology (IO) drugs are unclear.

MATERIALS AND METHODS

A retrospective study of lung cancer patients hospitalized in Tokyo Medical and Dental University was performed to clarify the association between TE and systemic therapy, especially IOs. Patients were divided into an IO cohort, a chemotherapy cohort (CT cohort), and a control cohort (patients without recurrence after surgery). Association studies of variables relevant to TE were performed.

RESULTS

A total of 592 patients were enrolled (IO cohort, 120; CT cohort, 294; control cohort, 178). Eight patients (6.7%) in the IO cohort, seven (2.4%) in the CT cohort, and three (1.7%) in the control cohort developed TE. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis identified IO, a history of TE, poor performance status (PS), and prior anticoagulation therapy as being associated with TE. Subsequent multivariate logistic regression analysis identified a history of TE (odds ratio (OR), 6.03; 95% confidence interval (CI), 2.09-17.40; P = 0.01) and poor PS (OR, 3.84; 95% CI, 1.34-11.00; P < 0.001) as potential risk factors for developing TE. The incidence of TE in the IO cohort patients with both of these characteristics was significantly higher (OR, 52.82; 95% CI, 6.72-506.37; P < 0.001) than that in the control cohort.

CONCLUSION

Lung cancer patients with a history of TE and poor PS are at increased risk of TE during treatment with IOs.

MICRO ABSTRACT

The profiles of lung cancer patients susceptible to development of thromboembolism (TE) during immunotherapy are unclear, even though TE is associated with a worse prognosis. Here, association studies of variables relevant to TE revealed that patients with a history of TE and poor performance status are at higher risk of developing TE during immunotherapy.

摘要

背景

血栓栓塞（TE）是肺癌患者的一种严重并发症；然而，免疫肿瘤学（IO）药物治疗期间发生TE的危险因素尚不清楚。

材料与方法

对东京医科齿科大学住院的肺癌患者进行回顾性研究，以阐明TE与全身治疗尤其是IO之间的关联。患者分为IO队列、化疗队列（CT队列）和对照队列（术后无复发患者）。对与TE相关的变量进行关联研究。

结果

共纳入592例患者（IO队列120例；CT队列294例；对照队列178例）。IO队列中有8例患者（6.7%）发生TE，CT队列中有7例（2.4%），对照队列中有3例（1.7%）。最小绝对收缩和选择算子（LASSO）回归分析确定IO、TE病史、较差的体能状态（PS）和既往抗凝治疗与TE相关。随后的多因素logistic回归分析确定TE病史（比值比（OR），6.03；95%置信区间（CI），2.09 - 17.40；P = 0.01）和较差的PS（OR，3.84；95% CI，1.34 - 11.00；P < 0.001）是发生TE的潜在危险因素。具有这两种特征的IO队列患者中TE的发生率显著高于对照队列（OR，52.82；95% CI，6.72 - 506.37；P < 0.001）。