Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan,
Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan.
Oncology. 2023;101(5):303-312. doi: 10.1159/000529204. Epub 2023 Jan 23.
Pleuroparenchymal fibroelastosis (PPFE) findings are associated with poor prognosis in interstitial lung disease (ILD). However, the effect of PPFE findings on the development of immune checkpoint inhibitor-related pneumonitis (ICI-pneumonitis), a life-threatening adverse event, in lung cancer patients with ILD has not been elucidated. We aimed to determine whether PPFE findings are a risk factor for ICI-pneumonitis in lung cancer patients with ILD.
We retrospectively examined 712 lung cancer patients, including 173 patients with background ILDs, who received ICI therapy in our institute between December 2015 and May 2021. Background ILDs were radiologically classified into three types: lone PPFE, other ILDs with PPFE, and other ILDs without PPFE. The cumulative ICI-pneumonitis incidence curves and median overall survival (mOS) were compared between the three radiological types, and risk factors for ICI-pneumonitis were evaluated.
Of 173 eligible patients with ILD, 23 patients (13.3%) experienced ICI-pneumonitis. The Kaplan-Meier method and the log-rank test showed that lone PPFE patients had significantly lower incidence of ICI-pneumonitis (p = 0.024) and longer mOS (575 vs. 326 days; p = 0.0096) than other ILDs patients. ICI-pneumonitis (p = 0.35) and mOS (p = 0.29) were not significantly different between other ILDs with and without PPFE. A multivariate Cox proportional hazards regression analysis revealed that lone PPFE pattern was an independent predictive factor for ICI-pneumonitis (hazard ratio, 0.20; 95% confidence interval, 0.043-0.93; p = 0.040).
ICI therapy could be safer in lone PPFE patients than in other ILDs patients with lung cancer.
胸膜肺弹力纤维增生症（PPFE）的表现与间质性肺疾病（ILD）的预后不良相关。然而，PPFE 表现对肺癌合并ILD 患者发生免疫检查点抑制剂相关肺炎（ICI-肺炎）这一危及生命的不良事件的影响尚未阐明。我们旨在确定 PPFE 表现是否是肺癌合并ILD 患者发生 ICI-肺炎的危险因素。
我们回顾性检查了我院于 2015 年 12 月至 2021 年 5 月期间接受 ICI 治疗的 712 例肺癌患者，其中 173 例患者有ILD 背景。ILD 背景通过影像学分为三型：单纯性 PPFE、伴 PPFE 的其他ILD 和不伴 PPFE 的其他ILD。比较三种影像学类型的 ICI-肺炎累积发生率曲线和中位总生存期（mOS），并评估 ICI-肺炎的危险因素。
在 173 例ILD 合格患者中，23 例（13.3%）发生了 ICI-肺炎。Kaplan-Meier 法和对数秩检验显示，单纯性 PPFE 患者的 ICI-肺炎发生率显著较低（p=0.024），mOS 更长（575 天 vs. 326 天；p=0.0096）。其他ILD 伴或不伴 PPFE 患者的 ICI-肺炎（p=0.35）和 mOS（p=0.29）均无显著差异。多变量 Cox 比例风险回归分析显示，单纯性 PPFE 模式是 ICI-肺炎的独立预测因素（危险比，0.20；95%置信区间，0.043-0.93；p=0.040）。
与其他ILD 合并肺癌患者相比，ICI 治疗在单纯性 PPFE 患者中可能更安全。
