Zhou Xiaoqing, Xu Yingnan, Ying Yuanyuan, Chen Ruilin, Wang Zhen, Lv Xin
The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China.
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Front Immunol. 2025 May 21;16:1607170. doi: 10.3389/fimmu.2025.1607170. eCollection 2025.
Immune checkpoint inhibitors (ICIs) significantly improve survival in lung cancer patients. However, checkpoint inhibitor pneumonitis (CIP) remains a critical safety concern. This meta-analysis systematically evaluates demographic, clinical, and laboratory risk factors associated with CIP development to guide risk-stratified management.
We systematically searched eight databases from inception to February 20, 2025. Study quality was assessed using the NOS. Adjusted risk factors from multivariate analyses were pooled in RevMan 5.4. Sensitivity analyses addressed heterogeneity, and funnel plots evaluated publication bias.
28 NOS-certified high-quality studies were included. 20 risk factors comprised: advanced age, male sex, smoking status, preexisting interstitial lung abnormalities, pulmonary fibrosis, COPD, thoracic radiotherapy history, squamous cell carcinoma histology (versus adenocarcinoma), early-stage NSCLC (Stage III versus IV), multifocal metastases (≥2 sites), PD-1 inhibitors (versus PD-L1 agents), elevated PD-L1 expression (≥50%), pembrolizumab use (versus nivolumab), AEC, CRP, PLR, WBC, and hypoalbuminemia. Sensitivity analyses confirmed consistency between FEM and REM; funnel plots indicated no publication bias.
This study identifies 20 independent CIP risk factors in ICI-treated lung cancer patients. Early screening and intervention for high-risk populations are critical to reducing CIP incidence and improving clinical outcomes. These findings provide actionable insights for optimizing ICI safety in real-world practice.
https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier CRD420250655469.
免疫检查点抑制剂（ICI）显著提高肺癌患者的生存率。然而，检查点抑制剂肺炎（CIP）仍然是一个关键的安全问题。本荟萃分析系统评估与CIP发生相关的人口统计学、临床和实验室风险因素，以指导风险分层管理。
我们系统检索了从数据库建立至2025年2月20日的八个数据库。使用NOS评估研究质量。在RevMan 5.4中汇总多变量分析的调整后风险因素。敏感性分析解决异质性问题，漏斗图评估发表偏倚。
纳入28项经NOS认证的高质量研究。20个风险因素包括：高龄、男性、吸烟状况、既往存在的间质性肺异常、肺纤维化、慢性阻塞性肺疾病（COPD）、胸部放疗史、鳞状细胞癌组织学类型（与腺癌相比）、早期非小细胞肺癌（III期与IV期）、多灶性转移（≥2个部位）、PD-1抑制剂（与PD-L1药物相比）、PD-L1表达升高（≥50%）、帕博利珠单抗的使用（与纳武利尤单抗相比）、中性粒细胞与淋巴细胞比值（AEC）、C反应蛋白（CRP）、血小板与淋巴细胞比值（PLR）、白细胞（WBC）和低白蛋白血症。敏感性分析证实固定效应模型（FEM）和随机效应模型（REM）之间具有一致性；漏斗图显示无发表偏倚。
本研究确定了接受ICI治疗的肺癌患者中20个独立的CIP风险因素。对高危人群进行早期筛查和干预对于降低CIP发生率和改善临床结局至关重要。这些发现为在实际临床实践中优化ICI安全性提供了可操作的见解。
https://www.crd.york.ac.uk/PROSPERO/myprospero，标识符CRD420250655469。
