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免疫检查点抑制剂相关肝炎的组织学特征及处理：一项回顾性描述性研究

Histological Characteristics and Management of Hepatitis on Immune Checkpoint Inhibitors: A Retrospective Descriptive Study.

作者信息

Parlati Lucia, Marcin Kennie, Terris Benoit, Vallet-Pichard Anaïs, Corouge Marion, Hollande Clémence, Sogni Philippe, Mallet Vincent, Pol Stanislas

机构信息

Faculty of Medicine, Université Paris Cité, Cochin Site, 24 rue du Faubourg Saint-Jacques, F-75006 Paris, France.

AP-HP. Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et Spécialités Médico-Chirurgicales, Service d'Hépatologie, F-75014 Paris, France.

出版信息

J Clin Med. 2023 May 29;12(11):3751. doi: 10.3390/jcm12113751.

DOI:10.3390/jcm12113751
PMID:37297945
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10253512/
Abstract

BACKGROUND AND AIMS

the side effects of immune checkpoint inhibitors (ICI) pose a problem for the clinical management of cancer patients. There is a lack of knowledge of the value of liver biopsy in patients with ICI-related drug-induced liver injury (ICI-DILI). The aim of this study was to explore the impact of liver biopsy on clinical management and response to corticosteroids, according to histological findings.

METHODS

We conducted a retrospective, single-center study to evaluate the biochemical, histological and clinical data of 35 patients with ICI-DILI between 2015 and 2021 in a university hospital in France.

RESULTS

Of the 35 patients with ICI-DILI (median [interquartile range] age 62 [48-73] years, 40% males) studied, 20 underwent a liver biopsy. There was no difference in the management of ICI-DILI according to liver biopsy in terms of ICI withdrawal, reduction or rechallenge. According to the histological profile, patients with toxic and granulomatous profiles had a better response to corticosteroids, while patients with cholangitic lesions had the worst response.

CONCLUSION

In ICI-DILI, liver biopsy must not delay patient care but may be useful in identifying patients with a cholangitic profile who have a poorer response to corticosteroids.

摘要

背景与目的

免疫检查点抑制剂（ICI）的副作用给癌症患者的临床管理带来了问题。对于ICI相关药物性肝损伤（ICI-DILI）患者，肝脏活检的价值尚缺乏了解。本研究的目的是根据组织学结果探讨肝脏活检对临床管理及对皮质类固醇反应的影响。

方法

我们进行了一项回顾性单中心研究，以评估2015年至2021年期间法国一家大学医院35例ICI-DILI患者的生化、组织学和临床数据。

结果

在研究的35例ICI-DILI患者中（年龄中位数[四分位间距]为62[48-73]岁，40%为男性），20例接受了肝脏活检。在ICI停药、减量或重新使用方面，根据肝脏活检情况对ICI-DILI进行的管理并无差异。根据组织学特征，具有毒性和肉芽肿性特征的患者对皮质类固醇反应较好，而具有胆管病变的患者反应最差。

结论

在ICI-DILI中，肝脏活检不应延误患者治疗，但可能有助于识别对皮质类固醇反应较差的胆管病变患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/04b1a0e926ce/jcm-12-03751-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/6a486ec5f7c9/jcm-12-03751-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/81183866351d/jcm-12-03751-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/75502085176b/jcm-12-03751-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/04b1a0e926ce/jcm-12-03751-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/6a486ec5f7c9/jcm-12-03751-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/81183866351d/jcm-12-03751-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/75502085176b/jcm-12-03751-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b32/10253512/04b1a0e926ce/jcm-12-03751-g004.jpg

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Clin Gastroenterol Hepatol. 2023 Mar;21(3):732-740. doi: 10.1016/j.cgh.2022.03.050. Epub 2022 Apr 26.
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Utility of Liver Biopsy in Diagnosis and Management of High-grade Immune Checkpoint Inhibitor Hepatitis in Patients With Cancer.
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Hepatotoxicity in Cancer Immunotherapy: Diagnosis, Management, and Future Perspectives.癌症免疫治疗中的肝毒性：诊断、管理及未来展望。
Cancers (Basel). 2024 Dec 29;17(1):76. doi: 10.3390/cancers17010076.
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