Liu Jiafan, Zhou Dongmei, Wu Na, Liu Jia, Wang Xiaonan
Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning Province, 110001, P.R. China.
BMC Geriatr. 2025 Apr 16;25(1):251. doi: 10.1186/s12877-025-05905-w.
Older patients with lung cancer are underrepresented in pivotal trials of immune checkpoint inhibitors (ICIs). This study primarily retrospectively evaluated the older patients with lung cancer treated with ICIs to determine which factors are related to the occurrence and prognosis of ICI-related pneumonitis (CIP).
We conducted a single-center, retrospective study of patients age ≥ 65 years diagnosed with lung cancer who received ICIs between January 2018 and June 2023 at the First Hospital of China Medical University. Clinical characteristics and blood parameters at baseline (before ICIs), at onset of pneumonitis (in the CIP group), and before the last dose of ICIs (in the non-CIP group) were collected and compared.
A total of 205 older patients with lung cancer were included, of which 51 (24%) patients developed CIP. Radiotherapy history, first line treatment, and the increased baseline systemic immune-inflammation index (SII), and CD4/CD8 were significantly and independently associated with the risk of CIP. Significant increase in CRP and decrease in albumin (ALB), prognostic nutritional index (PNI), and PaO were observed from baseline to CIP during treatment with ICIs. The PD-L1 expression status < 50% (P = 0.022) was the risk factor affecting their progression free survival (PFS). ECOG PS ≥ 2 (P = 0.031) and high-CRP (P = 0.007) of older patients were significantly correlated with their overall survival (OS), and patients who experienced CIP had a better OS than non-CIP (P = 0.001). The older patients with interstitial lung abnormalities (ILA) showed a shorter PFS than those without ILA (P = 0.036), and the PD-L1 expression status < 50% (P = 0.005), and low ALB (P = 0.023) was correlated with the OS in CIP.
Radiotherapy history, first line treatment (mostly in combination therapy), and increased baseline SII and CD4/CD8 were associated with the occurrence of CIP in older patients with lung cancer. PD-L1 expression status < 50%, ECOG PS ≥ 2 and high-CRP were associated with worse prognosis in all older patients. ILA, PD-L1 expression status < 50% and low-ALB at onset of CIP were related to poor prognosis in CIP.
老年肺癌患者在免疫检查点抑制剂（ICI）的关键试验中代表性不足。本研究主要对接受ICI治疗的老年肺癌患者进行回顾性评估，以确定哪些因素与ICI相关肺炎（CIP）的发生和预后有关。
我们对2018年1月至2023年6月在中国医科大学附属第一医院诊断为肺癌且年龄≥65岁并接受ICI治疗的患者进行了单中心回顾性研究。收集并比较了基线（ICI治疗前）、肺炎发作时（CIP组）和最后一剂ICI治疗前（非CIP组）的临床特征和血液参数。
共纳入205例老年肺癌患者，其中51例（24%）发生CIP。放疗史、一线治疗、基线全身免疫炎症指数（SII）升高以及CD4/CD8与CIP风险显著且独立相关。在ICI治疗期间，从基线到CIP时观察到CRP显著升高，白蛋白（ALB）、预后营养指数（PNI）和PaO降低。PD-L1表达状态<50%（P=0.022）是影响其无进展生存期（PFS）的危险因素。老年患者的ECOG PS≥2（P=0.031）和高CRP（P=0.007）与总生存期（OS）显著相关，发生CIP的患者OS优于未发生CIP的患者（P=0.001）。有间质性肺异常（ILA）的老年患者PFS短于无ILA的患者（P=0.036），且PD-L1表达状态<50%（P=0.005）和低ALB（P=0.023）与CIP患者的OS相关。
放疗史、一线治疗（大多为联合治疗）以及基线SII和CD4/CD8升高与老年肺癌患者CIP的发生有关。PD-L1表达状态<50%、ECOG PS≥2和高CRP与所有老年患者的预后较差有关。CIP发作时的ILA、PD-L1表达状态<50%和低ALB与CIP患者的预后不良有关。
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