Department of Pulmonary Medicine, Division of Internal Medicine, MD Anderson Cancer Center, Houston, TX.
Department of Internal Medicine, Baylor College of Medicine, Houston, TX.
Clin Lung Cancer. 2024 Nov;25(7):624-633.e2. doi: 10.1016/j.cllc.2024.07.017. Epub 2024 Aug 3.
Despite known short-term mortality risk of immune checkpoint inhibitor (ICI) pneumonitis, its impact on 1-year mortality, long-term pulmonary function, symptom persistence, and radiological resolution remains unclear.
We retrospectively analyzed 71 nonsmall cell lung cancer (NSCLC) patients treated with anti-PD(L)1 monoclonal antibodies between 2018-2021, who developed pneumonitis. Clinical and demographic covariates were collected from electronic medical record. Cox regression assessed associations with mortality, while logistic regression evaluated associations with persistent symptoms, hypoxemia, and radiological resolution.
Steroid-refractory pneumonitis (hazard ratio [HR] = 15.1, 95% confidence interval [95% CI]:3.9-57.8, P < .0001) was associated with higher 1-year mortality compared to steroid-responsive cases. However, steroid-resistant (odds ratio [OR] = 1.4, 95% CI: 0.4-5.1, P = .58) and steroid-dependent (OR = 0.4, 95% CI: 0.1-1.2, P = .08) pneumonitis were not. Nonadenocarcinoma histology (OR = 6.7, 95% CI: 1.6-46.6, P = .01), grade 3+ pneumonitis (OR = 4.6, 95% CI: 1.3-22.7, P = .03), and partial radiological resolution (OR = 6.3, 95% CI: 1.8-23.8, P = .004) were linked to increased pulmonary symptoms after pneumonitis resolution. Grade 3+ pneumonitis (OR = 8.1, 95% CI: 2.3-31.5, P = .001) and partial radiological resolution (OR = 5.45, 95% CI: 1.29-37.7, P = .03) associated with residual hypoxemia. Nonadenocarcinoma histology (OR = 3.6, 95% CI: 1.01-17.6, P = .06) and pretreatment ILAs (OR = 4.8, 95% CI: 1.14-33.09, P = .05) were associated with partial radiological resolution.
Steroid refractory pneumonitis increases 1-year mortality in NSCLC patients. Pretreatment ILAs may signal predisposition to fibrosis-related outcomes, seen as partial resolution, which in turn is associated with postresolution symptoms and residual hypoxemia. These findings offer insights for identifying patients at risk of adverse outcomes post-pneumonitis resolution.
尽管免疫检查点抑制剂（ICI）性肺炎的短期死亡率已知，但它对 1 年死亡率、长期肺功能、症状持续存在和影像学缓解的影响仍不清楚。
我们回顾性分析了 2018 年至 2021 年间接受抗 PD（L）1 单克隆抗体治疗的 71 例非小细胞肺癌（NSCLC）患者发生的肺炎。从电子病历中收集临床和人口统计学协变量。Cox 回归评估与死亡率的相关性，而 logistic 回归评估与持续性症状、低氧血症和影像学缓解的相关性。
与类固醇反应性病例相比，类固醇难治性肺炎（危险比[HR] = 15.1，95%置信区间[95%CI]：3.9-57.8，P<.0001）与 1 年死亡率较高相关。然而，类固醇耐药（比值比[OR] = 1.4，95%CI：0.4-5.1，P=.58）和类固醇依赖性（OR = 0.4，95%CI：0.1-1.2，P=.08）肺炎并非如此。非腺癌组织学（OR = 6.7，95%CI：1.6-46.6，P =.01）、3+级肺炎（OR = 4.6，95%CI：1.3-22.7，P =.03）和部分影像学缓解（OR = 6.3，95%CI：1.8-23.8，P =.004）与肺炎缓解后肺部症状增加有关。3+级肺炎（OR = 8.1，95%CI：2.3-31.5，P =.001）和部分影像学缓解（OR = 5.45，95%CI：1.29-37.7，P =.03）与残留低氧血症有关。非腺癌组织学（OR = 3.6，95%CI：1.01-17.6，P =.06）和治疗前白细胞介素（OR = 4.8，95%CI：1.14-33.09，P =.05）与部分影像学缓解有关。
类固醇难治性肺炎会增加 NSCLC 患者的 1 年死亡率。治疗前白细胞介素可能预示着与纤维化相关结局的易感性，表现为部分缓解，而部分缓解与缓解后症状和残留低氧血症有关。这些发现为识别肺炎缓解后发生不良结局的患者提供了思路。
