Jiang Aimin, Lu Haozheng, Zhao Rui, Yuan Jupeng, Chen Dawei
Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Department of Clinical Nutrition, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China.
Ther Adv Med Oncol. 2025 May 9;17:17588359251338624. doi: 10.1177/17588359251338624. eCollection 2025.
Current research presents conflicting evidence on whether pre-existing interstitial lung disease (ILD) serves as a risk factor for radiation pneumonitis (RP) and checkpoint inhibitor pneumonitis (CIP) in patients with lung cancer.
This study aims to systematically evaluate the impact of pre-existing ILD on the risk of developing RP and CIP in lung cancer patients.
A systematic review and meta-analysis was conducted using a random-effects model.
PubMed, Embase, and Web of Science were searched to identify relevant studies. A random-effects model was applied to estimate the risk and incidence of RP and CIP in lung cancer patients with pre-existing ILD compared to those without ILD. Sensitivity analyses were performed to assess the robustness of the pooled findings, and potential publication bias was evaluated using Begg's and Egger's tests.
A total of 12 studies involving 2576 patients were included in the RP risk assessment, while 29 studies with 8037 patients were analyzed for CIP risk. The pooled results indicated that pre-existing ILD significantly increased the risk of developing any-grade RP (odds ratio (OR): 3.63, 95% confidence interval (CI): 2.26-5.83) and severe RP (OR: 6.10, 95% CI: 2.68-13.86) in lung cancer patients. Subgroup analyses identified stereotactic body radiation therapy as the modality associated with the lowest risk of any-grade RP in these patients. Similarly, pre-existing ILD was associated with a significantly higher risk of any-grade CIP (OR: 3.86, 95% CI: 2.65-5.61) and severe CIP (OR: 3.24, 95% CI: 2.07-5.07), with anti-programmed cell death 1 therapies showing the highest CIP risk.
Pre-existing ILD markedly increases the risk of both RP and CIP in lung cancer patients. These findings underscore the critical importance of thorough ILD evaluation and the development of personalized treatment strategies to mitigate these risks prior to initiating cancer therapy.
目前的研究对于既往存在的间质性肺疾病（ILD）是否为肺癌患者放射性肺炎（RP）和检查点抑制剂肺炎（CIP）的危险因素提供了相互矛盾的证据。
本研究旨在系统评估既往存在的ILD对肺癌患者发生RP和CIP风险的影响。
采用随机效应模型进行系统评价和荟萃分析。
检索PubMed、Embase和Web of Science以识别相关研究。应用随机效应模型估计既往存在ILD的肺癌患者与无ILD的肺癌患者发生RP和CIP的风险及发生率。进行敏感性分析以评估汇总结果的稳健性，并使用Begg检验和Egger检验评估潜在的发表偏倚。
共有12项涉及2576例患者的研究纳入RP风险评估，29项涉及8037例患者的研究分析了CIP风险。汇总结果表明，既往存在的ILD显著增加了肺癌患者发生任何级别的RP（比值比（OR）：3.63，95%置信区间（CI）：2.26 - 5.83）和重度RP（OR：6.10，95%CI：2.68 - 13.86）的风险。亚组分析确定立体定向体部放射治疗是这些患者中与任何级别的RP风险最低相关的治疗方式。同样，既往存在的ILD与任何级别的CIP（OR：3.86，95%CI：2.65 - 5.61）和重度CIP（OR：3.24，95%CI：2.07 - 5.07）的显著更高风险相关，抗程序性细胞死亡1疗法显示出最高的CIP风险。
既往存在的ILD显著增加了肺癌患者发生RP和CIP的风险。这些发现强调了在开始癌症治疗之前对ILD进行全面评估以及制定个性化治疗策略以降低这些风险的至关重要性。
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