同期细菌性肺部感染对非小细胞肺癌患者免疫治疗的影响：一项回顾性队列研究。
The impact of concurrent bacterial lung infection on immunotherapy in patients with non-small cell lung cancer: a retrospective cohort study.
机构信息
Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China.
School of Medicine, Macao University of Science and Technology, Macao, Macao SAR, China.
出版信息
Front Cell Infect Microbiol. 2023 Aug 29;13:1257638. doi: 10.3389/fcimb.2023.1257638. eCollection 2023.
OBJECTIVE
To find out how bacterial lung infections (BLI) affect the effectiveness of therapy and the rate of pneumonia caused by pneumonia related to checkpoint inhibitors (CIP) in patients with non-small cell lung cancer (NSCLC) who are getting immunotherapy with checkpoint inhibitors (ICIs).
PATIENTS AND METHODS
507 NSCLC patients who received at least two ICI treatments between June 2020 and December 2022 at the Affiliated Hospital of Kunming University of Science and Technology(AHKUST) were included in a retrospective cohort study. Based on whether there was a concurrent BLI diagnosis from high-resolution CT scans of the chest, the patients were divided into two groups: 238 in the NSCLC with BLI group (NSCLC-BLI group), and 269 in the NSCLC alone group. The collected therapeutic outcome measures included the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and the incidence rate of CIP. We analyzed the effect of BLI on the therapeutic efficacy of ICI treatment and the incidence rate of CIP in NSCLC patients.Inclusion criteria based on NSCLC patients staged I to IV according to the 8th edition of the International Association for Lung Cancer Research (IASLC).
RESULTS
The NSCLC-BLI group showed superior ORR to the NSCLC group when treated with ICIs. Multifactorial logistic regression and Cox analyses, adjusted for confounders, identified BLI as an independent positive prognostic factor for ORR (HR=0.482, 95%CI: 0.391-0.550; P<0.001) and PFS (HR=0.619; 95%CI: 0.551-0.771; P<0.001). No correlation between BLI and OS was found. Out of 26 cases of CIP, 12 were in the NSCLC-BLI group and 14 in the NSCLC group, with no significant difference in incidence (P=0.145).
CONCLUSION
NSCLC patients with BLI receiving ICI treatment show superior ORR and PFS compared to NSCLC alone without an increased CIP risk, positioning BLI as a predictive factor for improved outcomes in NSCLC patients receiving ICIs. However, the study has limitations including its retrospective nature and lacking data on BLI bacteria types and levels, which could influence therapy outcomes.
目的
探究细菌性肺部感染（BLI）对接受免疫检查点抑制剂（ICI）治疗的非小细胞肺癌（NSCLC）患者的治疗效果和肺炎相关免疫检查点抑制剂（CIP）引起的肺炎发生率的影响。
方法
回顾性分析 2020 年 6 月至 2022 年 12 月于昆明医科大学附属延安医院接受至少 2 次 ICI 治疗的 507 例 NSCLC 患者的临床资料，根据胸部高分辨率 CT 扫描是否存在并发 BLI 诊断，将患者分为 NSCLC 合并 BLI 组（NSCLC-BLI 组）和单纯 NSCLC 组。收集的治疗结局指标包括客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）和 CIP 发生率。分析 BLI 对 NSCLC 患者 ICI 治疗疗效和 CIP 发生率的影响。纳入标准为根据第 8 版国际肺癌研究协会（IASLC）分期的Ⅰ~Ⅳ期 NSCLC 患者。
结果
与单纯 NSCLC 组相比，接受 ICI 治疗的 NSCLC-BLI 组患者的 ORR 更高。多因素逻辑回归和 Cox 分析，调整混杂因素后，发现 BLI 是 ORR（HR=0.482，95%CI：0.391-0.550；P<0.001）和 PFS（HR=0.619；95%CI：0.551-0.771；P<0.001）的独立正预后因素。BLI 与 OS 无相关性。在 26 例 CIP 中，12 例发生在 NSCLC-BLI 组，14 例发生在 NSCLC 组，发生率无差异（P=0.145）。
结论
接受 ICI 治疗的合并 BLI 的 NSCLC 患者的 ORR 和 PFS 优于单纯 NSCLC，且 CIP 风险无增加，提示 BLI 是接受 ICI 治疗的 NSCLC 患者获得更好结局的预测因素。但是，本研究存在一定的局限性，包括回顾性研究的性质以及缺乏 BLI 细菌类型和水平的数据，这些因素可能会影响治疗结果。
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