Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
BMC Med. 2024 Jan 31;22(1):44. doi: 10.1186/s12916-024-03261-x.
BACKGROUND: Immune checkpoint inhibitors (ICIs) have contributed to a significant advancement in the treatment of cancer, leading to improved clinical outcomes in many individuals with advanced disease. Both preclinical and clinical investigations have shown that ICIs are associated with atherosclerosis and other cardiovascular events; however, the exact mechanism underlying this relationship has not been clarified. METHODS: Patients diagnosed with stages III or IV non-small cell lung cancer (NSCLC) at the Wuhan Union Hospital from March 1, 2020, to April 30, 2022, were included in this retrospective study. Coronary artery calcium (CAC) volume and score were assessed in a subset of patients during non-ECG-gated chest CT scans at baseline and 3, 6, and 12 months after treatment. Propensity score matching (PSM) was performed in a 1:1 ratio to balance the baseline characteristics between the two groups. RESULTS: Overall, 1458 patients (487 with ICI therapy and 971 without ICI therapy) were enrolled in this cardiovascular cohort study. After PSM, 446 patients were included in each group. During the entire period of follow-up (median follow-up 23.1 months), 24 atherosclerotic cardiovascular disease (ASCVD) events (4.9%) occurred in the ICI group, and 14 ASCVD events (1.4%) in the non-ICI group, before PSM; 24 ASCVD events (5.4%) occurred in the ICI group and 5 ASCVD events (1.1%) in the non-ICI group after PSM. The CAC imaging study group comprised 113 patients with ICI therapy and 133 patients without ICI therapy. After PSM, each group consisted of 75 patients. In the ICI group, the CAC volume/score increased from 93.4 mm/96.9 (baseline) to 125.1 mm/132.8 (at 12 months). In the non-ICI group, the CAC volume/score was increased from 70.1 mm/68.8 (baseline) to 84.4 mm/87.9 (at 12 months). After PSM, the CAC volume/score was increased from 85.1 mm/76.4 (baseline) to 111.8 mm/121.1 (12 months) in the ICI group and was increased from 74.9 mm/76.8 (baseline) to 109.3 mm/98.7 (12 months) in the non-ICI group. Both cardiovascular events and CAC progression were increased after the initiation of ICIs. CONCLUSIONS: Treatment with ICIs was associated with a higher rate of ASCVD events and a noticeable increase in CAC progression.
背景：免疫检查点抑制剂（ICIs）在癌症治疗方面取得了重大进展，使许多晚期疾病患者的临床结局得到改善。临床前和临床研究均表明，ICI 与动脉粥样硬化和其他心血管事件有关；然而，这种关系的确切机制尚未阐明。
方法：本回顾性研究纳入了 2020 年 3 月 1 日至 2022 年 4 月 30 日期间在武汉协和医院诊断为 III 或 IV 期非小细胞肺癌（NSCLC）的患者。在基线和治疗后 3、6 和 12 个月，对部分患者在非心电图门控胸部 CT 扫描期间评估冠状动脉钙（CAC）体积和评分。采用倾向评分匹配（PSM）以 1:1 的比例平衡两组的基线特征。
结果：总体而言，这项心血管队列研究纳入了 1458 例患者（ICI 治疗组 487 例，无 ICI 治疗组 971 例）。PSM 后，每组纳入 446 例患者。在整个随访期间（中位随访 23.1 个月），ICI 组发生 24 例动脉粥样硬化性心血管疾病（ASCVD）事件（4.9%），无 ICI 组发生 14 例 ASCVD 事件（1.4%）；PSM 前，ICI 组发生 24 例 ASCVD 事件（5.4%），无 ICI 组发生 5 例 ASCVD 事件（1.1%）。CAC 影像学研究组包括 113 例接受 ICI 治疗的患者和 133 例未接受 ICI 治疗的患者。PSM 后，每组各有 75 例患者。ICI 组的 CAC 体积/评分从基线时的 93.4 mm/96.9 增加到 125.1 mm/132.8（12 个月）。非 ICI 组的 CAC 体积/评分从基线时的 70.1 mm/68.8 增加到 84.4 mm/87.9（12 个月）。PSM 后，ICI 组的 CAC 体积/评分从基线时的 85.1 mm/76.4 增加到 111.8 mm/121.1（12 个月），而非 ICI 组的 CAC 体积/评分从基线时的 74.9 mm/76.8 增加到 109.3 mm/98.7（12 个月）。ICI 治疗开始后，心血管事件和 CAC 进展均增加。
结论：ICI 治疗与 ASCVD 事件发生率升高和 CAC 进展明显相关。
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