可切除 NSCLC 新辅助免疫化疗后免疫检查点抑制剂相关肺炎的危险因素。

Risk factors of immune checkpoint inhibitor-related pneumonitis after neoadjuvant immunochemotherapy for resectable NSCLC.

机构信息

Department of Respiratory Medicine, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, 310000, Zhejiang, China.

Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.

出版信息

BMC Pulm Med. 2024 May 23;24(1):253. doi: 10.1186/s12890-024-03041-6.

DOI:10.1186/s12890-024-03041-6

PMID:38783253

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11112843/

Abstract

BACKGROUND

The incidence of checkpoint inhibitor-associated pneumonitis (CIP) in advanced non-small cell lung cancer (NSCLC) has been substantiated through large-scale clinical trials or real-world studies. However, reports on CIP incidence within the context of neoadjuvant immunotherapy for resectable NSCLC remain scarce. This study endeavors to investigate the incidence, risk factors, and outcomes of CIP in patients with resectable NSCLC receiving neoadjuvant immunochemotherapy.

METHODS

A retrospective, case-control study was conducted on patients diagnosed with NSCLC stages IIA-IIIB who received neoadjuvant immunochemotherapy between January 2018 and September 2022. Patients were stratified into two groups based on the presence or absence of CIP, facilitating a comparative analysis of clinical characteristics, treatment modalities, physiological indicators, and prognostic outcomes .

RESULTS

The study cohort comprised 245 patients, with 11.4% (28/245) experiencing CIP. The median period of CIP onset was 70 (range, 40-221) days. The incidence of severe CIP (grade 3-4) was 3.7% (9/245). Patients with CIP showed a higher all-cause mortality rate of 21.4% (6/28) compared to that of patients without CIP. Those who developed CIP exhibited elevated body mass index (BMI) values (p = 0.028) and increased fibrinogen (FIB) levels (p < 0.001), alongside a significant decrease in both diffusing capacity for carbon monoxide (DLCO)% pred (p = 0.001) and DLCO/VA% pred (p = 0.021) after neoadjuvant therapy compared to pre-indicators. Receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve of three assessed variables (FIB levels, BMI, DLCO) reached 0.806 in predicting CIP occurrence at an early stage.

CONCLUSIONS

This cohort demonstrated that elevated BMI, increased FIB levels, and decreased pulmonary diffusion function after neoadjuvant therapy are risk factors of CIP occurrence. Early assessment and continuous monitoring of these indicators are imperative for the predictive identification of CIP, enhancing patient management and outcomes.

摘要

背景

在大型临床试验或真实世界研究中已经证实，晚期非小细胞肺癌（NSCLC）患者接受检查点抑制剂治疗后会发生免疫相关肺炎（CIP）。然而，有关新辅助免疫治疗可切除 NSCLC 患者 CIP 发生率的报告仍然很少。本研究旨在调查接受新辅助免疫化疗的可切除 NSCLC 患者中 CIP 的发生率、危险因素和结局。

方法

本研究为回顾性病例对照研究，纳入 2018 年 1 月至 2022 年 9 月期间接受新辅助免疫化疗的 IIA-IIIB 期 NSCLC 患者。根据是否发生 CIP，将患者分为两组，对临床特征、治疗方式、生理指标和预后结局进行比较分析。

结果

研究队列包括 245 例患者，其中 11.4%（28/245）发生 CIP。CIP 发病中位时间为 70（40-221）天。严重 CIP（3-4 级）发生率为 3.7%（9/245）。发生 CIP 的患者总死亡率为 21.4%（6/28），高于未发生 CIP 的患者（p=0.028）。发生 CIP 的患者体质量指数（BMI）较高（p=0.028），纤维蛋白原（FIB）水平较高（p<0.001），新辅助治疗后一氧化碳弥散量（DLCO）%预测值（p=0.001）和 DLCO/VA%预测值（p=0.021）均显著降低。受试者工作特征曲线（ROC）分析显示，治疗后 3 个评估变量（FIB 水平、BMI、DLCO）的 ROC 曲线下面积（AUC）预测 CIP 早期发生的 AUC 为 0.806。