Gao Jaynelle, Chung Ryan S, Chwa Jason, Hur Kevin
Keck School of Medicine University of Southern California California Los Angeles USA.
Caruso Department of Otolaryngology-Head and Neck Surgery Keck School of Medicine of University of Southern California California Los Angeles USA.
Laryngoscope Investig Otolaryngol. 2025 May 14;10(3):e70148. doi: 10.1002/lio2.70148. eCollection 2025 Jun.
Immune checkpoint inhibitors (ICIs) are widely used for cancer therapy and are associated with immune-related adverse events (irAEs) in various organ systems. However, data on sinonasal irAEs remain limited. This study investigates the association between ICI therapy and sinonasal conditions, including chronic rhinosinusitis (CRS) and nasal polyps, using a national health database.
This retrospective cohort study utilized the TriNetX US Network to analyze adults diagnosed with malignant neoplasms for which ICIs are an accepted treatment option. Patients treated with FDA-approved ICIs (pembrolizumab, nivolumab, cemiplimab, atezolizumab, durvalumab, avelumab, or ipilimumab) were compared to those not receiving ICIs. Exclusion criteria included sinonasal neoplasms and prior sinus surgery. Propensity score matching on age, race, sex, and asthma diagnosis was performed. Outcomes included first-time diagnoses of CRS, nasal polyps, and cardinal symptoms of CRS. Subgroup analyses by ICI mechanism of action and a post hoc analysis of all-cause mortality were conducted.
ICI therapy was associated with a decreased likelihood of CRS diagnosis (OR 0.90, 95% CI 0.85-0.96), nasal polyp diagnosis (OR 0.65, 95% CI 0.51-0.83), and facial pain (OR 0.74, 95% CI 0.56-0.99). Conversely, patients receiving ICIs had an increased likelihood of anosmia/parosmia or parageusia (OR 1.86, 95% CI 1.68-2.07), and rhinorrhea (OR 1.16, 95% CI 1.10-1.22). Subgroup analyses supported these findings across different ICI categories. Risk of mortality was higher among ICI-treated patients (HR 4.09, 95% CI 4.02-4.16).
This is the first propensity-matched study to evaluate the relationship between ICI therapy and sinonasal conditions, revealing a decreased risk of CRS and nasal polyps in patients undergoing ICI therapy. Future studies are needed to explore the clinical significance and mechanism of ICI-related sinonasal symptoms.
免疫检查点抑制剂（ICIs）广泛用于癌症治疗，并与各个器官系统的免疫相关不良事件（irAEs）有关。然而，关于鼻窦irAEs的数据仍然有限。本研究使用国家卫生数据库调查ICI治疗与鼻窦疾病之间的关联，包括慢性鼻窦炎（CRS）和鼻息肉。
这项回顾性队列研究利用TriNetX美国网络分析被诊断患有恶性肿瘤且ICI是公认治疗选择的成年人。将接受FDA批准的ICIs（帕博利珠单抗、纳武利尤单抗、西米普利单抗、阿替利珠单抗、度伐利尤单抗、阿维鲁单抗或伊匹木单抗）治疗的患者与未接受ICIs治疗的患者进行比较。排除标准包括鼻窦肿瘤和既往鼻窦手术史。对年龄、种族、性别和哮喘诊断进行倾向评分匹配。结局包括CRS、鼻息肉的首次诊断以及CRS的主要症状。进行了按ICI作用机制的亚组分析和全因死亡率的事后分析。
ICI治疗与CRS诊断可能性降低（OR 0.90，95%CI 0.85 - 0.96）、鼻息肉诊断可能性降低（OR 0.65，95%CI 0.51 - 0.83）以及面部疼痛（OR 0.74，95%CI 0.56 - 0.99）相关。相反，接受ICIs治疗的患者嗅觉减退/嗅觉异常或味觉异常的可能性增加（OR 1.86，95%CI 1.68 - 2.07），以及鼻漏的可能性增加（OR 1.16，95%CI 1.10 - 1.22）。亚组分析在不同ICI类别中支持了这些发现。ICI治疗患者的死亡风险更高（HR 4.09，95%CI 4.02 - 4.16）。
这是第一项评估ICI治疗与鼻窦疾病之间关系的倾向匹配研究，揭示了接受ICI治疗的患者CRS和鼻息肉风险降低。未来需要进一步研究探索ICI相关鼻窦症状的临床意义和机制。
3级。
