亚洲与非亚洲局部晚期非小细胞肺癌患者放化疗后肺炎的比较：一项系统评价与荟萃分析
Comparison of post-chemoradiotherapy pneumonitis between Asian and non-Asian patients with locally advanced non-small cell lung cancer: a systematic review and meta-analysis.
作者信息
Liu Tingting, Li Sihan, Ding Silu, Qiu Jingping, Ren Chengbo, Chen Jun, Wang He, Wang Xiaoling, Li Guang, He Zheng, Dang Jun
机构信息
Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China.
Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China.
出版信息
EClinicalMedicine. 2023 Sep 25;64:102246. doi: 10.1016/j.eclinm.2023.102246. eCollection 2023 Oct.
BACKGROUND
Pneumonitis is a common complication for patients with locally advanced non-small cell lung cancer undergoing definitive chemoradiotherapy (CRT). It remains unclear whether there is ethnic difference in the incidence of post-CRT pneumonitis.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies from January 1, 2000 to April 30, 2023. The outcomes of interest were incidence rates of pneumonitis. The random-effect model was used for statistical analysis. This meta-analysis was registered with PROSPERO (CRD42023416490).
FINDINGS
A total of 248 studies involving 28,267 patients were included. Among studies of CRT without immunotherapy, the pooled rates of pneumonitis for Asian patients were significantly higher than that for non-Asian patients (all grade: 66.8%, 95% CI: 59.2%-73.9% vs. 28.1%, 95% CI: 20.4%-36.4%; P < 0.0001; grade ≥2: 25.1%, 95% CI: 22.9%-27.3% vs. 14.9%, 95% CI: 12.0%-18.0%; P < 0.0001; grade ≥3: 6.5%, 95% CI: 5.6%-7.3% vs. 4.6%, 95% CI: 3.4%-5.9%; P = 0.015; grade 5: 0.6%, 95% CI: 0.3%-0.9% vs. 0.1%, 95% CI: 0.0%-0.2%; P < 0.0001). Regarding studies of CRT plus immunotherapy, Asian patients had higher rates of all-grade (74.8%, 95% CI: 63.7%-84.5% vs. 34.3%, 95% CI: 28.7%-40.2%; P < 0.0001) and grade ≥2 (34.0%, 95% CI: 30.7%-37.3% vs. 24.6%, 95% CI: 19.9%-29.3%; P = 0.001) pneumonitis than non-Asian patients, but with no significant differences in the rates of grade ≥3 and grade 5 pneumonitis. Results from subgroup analyses were generally similar to that from the all studies. In addition, the pooled median/mean of lung volume receiving ≥20 Gy and mean lung dose were relatively low in Asian studies compared to that in non-Asian studies.
INTERPRETATION
Asian patients are likely to have a higher incidence of pneumonitis than non-Asian patients, which appears to be due to the poor tolerance of lung to radiation. Nevertheless, these findings are based on observational studies and with significant heterogeneity, and need to be validated in future large prospective studies focusing on the subject.
FUNDING
None.
背景
肺炎是接受根治性放化疗（CRT）的局部晚期非小细胞肺癌患者的常见并发症。CRT后肺炎的发病率是否存在种族差异仍不清楚。
方法
检索了PubMed、Embase、Cochrane图书馆和Web of Science，查找2000年1月1日至2023年4月30日期间的符合条件的研究。感兴趣的结果是肺炎的发病率。采用随机效应模型进行统计分析。该荟萃分析已在PROSPERO（CRD42023416490）注册。
结果
共纳入248项研究，涉及28267例患者。在未接受免疫治疗的CRT研究中，亚洲患者肺炎的合并发生率显著高于非亚洲患者（所有级别：66.8%，95%CI：59.2%-73.9% 对比 28.1%，95%CI：20.4%-36.4%；P<0.0001；2级及以上：25.1%，95%CI：22.9%-27.3% 对比 14.9%，95%CI：12.0%-18.0%；P<0.0001；3级及以上：6.5%，95%CI：5.6%-7.3% 对比 4.6%，95%CI：3.4%-5.9%；P=0.015；5级：0.6%，95%CI：0.3%-0.9% 对比 0.1%，95%CI：0.0%-0.2%；P<0.0001）。关于CRT联合免疫治疗的研究，亚洲患者所有级别（74.8%，95%CI：63.7%-84.5% 对比 34.3%，95%CI：28.7%-40.2%；P<0.0001）和2级及以上（34.0%，95%CI：30.7%-37.3% 对比 24.6%，95%CI：19.9%-29.3%；P=0.001）肺炎的发生率高于非亚洲患者，但3级及以上和5级肺炎的发生率无显著差异。亚组分析结果与所有研究的结果总体相似。此外，与非亚洲研究相比，亚洲研究中接受≥20 Gy的肺体积的合并中位数/均值和平均肺剂量相对较低。
解读
亚洲患者发生肺炎的可能性可能高于非亚洲患者，这似乎是由于肺对放疗的耐受性较差。然而，这些发现基于观察性研究且存在显著异质性，需要在未来针对该主题的大型前瞻性研究中进行验证。
资金来源
无。
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