Department of Medical Oncology, The First People's Hospital of Linping District, No. 369, Yingbin Road, Nanyuan Street, Linping District, Hangzhou, 31110, Zhejiang Province, China.
BMC Pulm Med. 2024 Aug 14;24(1):393. doi: 10.1186/s12890-024-03180-w.
Lung cancer, a leading cause of cancer mortality, poses significant treatment challenges. The use of immune checkpoint inhibitors (ICIs) has revolutionized therapy, but it is associated with immune-related pneumonitis (IRP). This study systematically reviews and analyzes the impact of Chronic Obstructive Pulmonary Disease (COPD) on the risk of IRP in lung cancer patients undergoing immunotherapy.
Adhering to PRISMA guidelines and using the PICO framework, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted. Inclusion criteria encompassed peer-reviewed studies involving lung cancer patients treated with ICIs, comparing those with and without COPD. The primary outcome was the incidence and risk of IRP. The Newcastle-Ottawa Scale evaluated study quality. The effect size was calculated using random or fixed-effects models based on the observed heterogeneity. We assessed the heterogeneity between studies and conducted a sensitivity analysis.
The search identified 1026 articles, with six meeting the criteria for inclusion. Studies varied in design and geography, predominantly retrospective cohort studies. Patients with COPD had an increased risk of IRP (OR = 1.54, 95% CI [1.24, 1.92, P < 0.01). Subgroup analysis based on radiation therapy exposure (< 40% and ≥ 40%) also indicated a heightened IRP risk in COPD patients. Sensitivity analysis affirmed the robustness of the results, and publication bias was not significant.
Lung cancer patients with COPD undergoing immunotherapy have a significantly increased risk of developing IRP. This highlights the necessity for vigilant monitoring and individualized treatment strategies to improve the safety and effectiveness of immunotherapy in this group.
肺癌是癌症死亡的主要原因，其治疗具有很大的挑战性。免疫检查点抑制剂（ICIs）的应用彻底改变了治疗方法，但与免疫相关的肺炎（IRP）有关。本研究系统地回顾和分析了慢性阻塞性肺疾病（COPD）对接受免疫治疗的肺癌患者发生 IRP 的风险的影响。
遵循 PRISMA 指南并使用 PICO 框架，对 PubMed、Embase、Web of Science 和 Cochrane Library 进行了全面检索。纳入标准包括涉及接受 ICI 治疗的肺癌患者的同行评审研究，比较了有和无 COPD 的患者。主要结局是 IRP 的发生率和风险。使用纽卡斯尔-渥太华量表评估研究质量。根据观察到的异质性，使用随机或固定效应模型计算效应量。我们评估了研究之间的异质性并进行了敏感性分析。
搜索共识别出 1026 篇文章，其中 6 篇符合纳入标准。研究在设计和地理位置上存在差异，主要是回顾性队列研究。COPD 患者发生 IRP 的风险增加（OR=1.54，95%CI[1.24，1.92，P<0.01）。基于放疗暴露（<40%和≥40%）的亚组分析也表明 COPD 患者的 IRP 风险更高。敏感性分析证实了结果的稳健性，且不存在发表偏倚。
接受免疫治疗的肺癌合并 COPD 患者发生 IRP 的风险显著增加。这突显了在这一人群中，需要进行警惕监测和个体化治疗策略，以提高免疫治疗的安全性和有效性。
