Sugiyama Yuya, Tanabe Hiroki, Matsuya Taisuke, Kobayashi Yu, Murakami Yuki, Sasaki Takahiro, Kunogi Takehito, Takahashi Keitaro, Ando Katsuyoshi, Ueno Nobuhiro, Kashima Shin, Moriichi Kentaro, Tanino Mishie, Mizukami Yusuke, Fujiya Mikihiro, Okumura Toshikatsu
Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Department of Dermatology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Endosc Int Open. 2022 Jul 15;10(7):E982-E989. doi: 10.1055/a-1839-4303. eCollection 2022 Jul.
Recent advances in cancer treatment have involved the clinical application of immune checkpoint inhibitors (ICIs) for various type of cancers. The adverse events associated with ICIs are generally referred to as immune-related adverse events (irAEs). Gastrointestinal irAEs are a major disorder, but gastritis is not frequently observed. The aims of this study were to elucidate the clinical, endoscopic, and histological characteristics of irAE gastritis. Information on patients treated with ICIs were collected from a single institute over 3 years. IrAE gastritis was identified based on the clinical course and endoscopic and histopathological findings. Of the 359 patients treated with ICIs, four cases of irAE gastritis were identified in clinical records from the endoscopy unit. The endoscopic and histopathological findings were analyzed, and further immunohistochemical studies with immune subtype markers and programmed cell death ligand-1 (PD-L1) antibody were conducted. Among four patients with irAE gastritis, the remarkable endoscopic characteristics were network-pattern erosion, erythematous and edematous mucosa with thick purulent discharge, and fragile mucosa. Corresponding histological features were fibrinopurulent exudate, severe inflammatory cell infiltration, and epithalaxia, respectively. The PD-L1 expression rate was ≥ 1 % in the gastric tissue of all patients with gastritis. These patients were treated with prednisolone (PSL) and their symptoms improved within a few days to 2 weeks. IrAE gastritis were characterized by specific endoscopic findings. The appropriate endoscopic diagnosis may lead to effective treatment with PSL.
癌症治疗的最新进展涉及免疫检查点抑制剂（ICI）在各种癌症中的临床应用。与ICI相关的不良事件通常被称为免疫相关不良事件（irAE）。胃肠道irAE是一种主要疾病，但胃炎并不常见。本研究的目的是阐明irAE胃炎的临床、内镜和组织学特征。在3年多的时间里，从单一机构收集了接受ICI治疗的患者的信息。根据临床病程以及内镜和组织病理学检查结果确定irAE胃炎。在359例接受ICI治疗的患者中，在内镜科的临床记录中发现了4例irAE胃炎。对内镜和组织病理学检查结果进行了分析，并进一步使用免疫亚型标志物和程序性细胞死亡配体-1（PD-L1）抗体进行了免疫组化研究。在4例irAE胃炎患者中，显著的内镜特征为网状糜烂、伴有浓稠脓性分泌物的红斑和水肿黏膜以及脆弱黏膜。相应的组织学特征分别为纤维蛋白脓性渗出物、严重炎症细胞浸润和上皮脱落。所有胃炎患者胃组织中的PD-L1表达率均≥1%。这些患者接受了泼尼松龙（PSL）治疗，症状在几天至2周内得到改善。irAE胃炎具有特定的内镜表现。适当的内镜诊断可能会使PSL治疗有效。
