Kuo Chin-Wei, Lin Chien-Yu, Wei Sheng-Huan, Chou Yun-Tse, Chen Chian-Wei, Tsai Jeng-Shiuan, Su Po-Lan, Lin Chien-Chung
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan.
Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
Ther Adv Med Oncol. 2023 Sep 14;15:17588359231198454. doi: 10.1177/17588359231198454. eCollection 2023.
Invasive pulmonary aspergillosis (IPA) can negatively impact cancer patients' survival. It remains uncertain whether IPA's impact on patient outcomes varies by treatment approach in advanced lung cancer.
To explore the association between IPA and outcomes in patients with advanced lung cancer receiving different treatments.
A retrospective cohort study.
We enrolled patients with advanced-stage lung cancer between 2013 and 2021 at a college hospital in Taiwan and used the 2021 European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium consensus for IPA diagnosis. Multivariable logistic regression was used to identify the IPA risk factors. We compared overall survival (OS) and postgalactomannan (GM) test survival between the IPA and control groups using multivariable Cox proportional hazards regression and the Kaplan-Meier method with propensity score matching (PSM).
Among 2543 patients with advanced-stage lung cancer, 290 underwent a GM test, of which 34 (11.7%) were diagnosed with IPA. Patients undergoing chemotherapy (HR = 4.02, = 0.027) and immunotherapy [hazard ratio (HR) = 3.41, = 0.076] tended to have IPA. Compared to the control group, the IPA group had shorter median OS (14.4 9.9 months, = 0.030) and post-GM test survival (4.5 1.9 months, = 0.003). IPA was associated with shorter OS (log-rank = 0.014 and 0.018 before and after PSM, respectively) and shorter 1-year and 2-year survival post-GM test (HR = 1.65 and 1.66, respectively). Patients receiving chemotherapy or immunotherapy had a shorter post-GM test survival if they had IPA.
IPA tended to be diagnosed more frequently in patients receiving chemotherapy or immune checkpoint inhibitors. Patients diagnosed with IPA are associated with shorter survival. Larger cohort studies are needed to verify the observations.
侵袭性肺曲霉病（IPA）会对癌症患者的生存产生负面影响。在晚期肺癌中，IPA对患者预后的影响是否因治疗方法而异仍不确定。
探讨接受不同治疗的晚期肺癌患者中IPA与预后之间的关联。
一项回顾性队列研究。
我们纳入了2013年至2021年期间台湾一所大学医院的晚期肺癌患者，并采用2021年欧洲癌症研究与治疗组织/真菌病研究组教育与研究联盟关于IPA诊断的共识。使用多变量逻辑回归来确定IPA的危险因素。我们使用多变量Cox比例风险回归以及倾向评分匹配（PSM）的Kaplan-Meier方法比较了IPA组和对照组之间的总生存期（OS）和半乳甘露聚糖（GM）检测后的生存期。
在2543例晚期肺癌患者中，290例接受了GM检测，其中34例（11.7%）被诊断为IPA。接受化疗（HR = 4.02，P = 0.027）和免疫治疗[风险比（HR）= 3.41，P = 0.076]的患者更容易发生IPA。与对照组相比，IPA组的中位OS较短（14.4对9.9个月，P = 0.030），GM检测后的生存期也较短（4.5对1.9个月，P = 0.003）。IPA与较短的OS相关（PSM前后的对数秩P分别为0.014和0.018），以及GM检测后较短的1年和2年生存期（HR分别为1.65和1.66）。接受化疗或免疫治疗的患者如果发生IPA，其GM检测后的生存期较短。
接受化疗或免疫检查点抑制剂治疗的患者中IPA的诊断频率往往更高。被诊断为IPA的患者生存期较短。需要更大规模的队列研究来验证这些观察结果。
