接受免疫检查点抑制剂治疗的非小细胞肺癌患者肺炎后的长期临床、放射学和死亡率结果：回顾性分析

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2024-08-03 DOI:10.1016/j.cllc.2024.07.017

Felipe Soto-Lanza , Lydia Glick , Colin Chan , Linda Zhong , Nathaniel Wilson , Saadia Faiz , Saumil Gandhi , Aung Naing , John V. Heymach , Vickie R. Shannon , Maria Franco-Vega , Zhongxing Liao , Steven H. Lin , Nicolas L. Palaskas , Jia Wu , Girish S. Shroff , Mehmet Altan , Ajay Sheshadri

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引用次数: 0

摘要

目的：尽管已知免疫检查点抑制剂（ICI）肺炎有短期死亡风险，但其对1年死亡率、长期肺功能、症状持续性和放射学分辨率的影响仍不清楚：我们回顾性分析了2018-2021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，这些患者均出现了肺炎。从电子病历中收集了临床和人口统计学协变量。Cox回归评估了与死亡率的关系，而Logistic回归评估了与持续症状、低氧血症和放射学分辨率的关系：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）与类固醇反应性病例相比，1 年死亡率更高。然而，类固醇耐药（几率比[OR] = 1.4，95% CI：0.4-5.1，P = .58）和类固醇依赖（OR = 0.4，95% CI：0.1-1.2，P = .08）性肺炎则与之无关。非腺癌组织学（OR = 6.7，95% CI：1.6-46.6，P = .01）、3 级以上肺炎（OR = 4.6，95% CI：1.3-22.7，P = .03）和部分放射学缓解（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）和部分放射学缓解（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 ILAs（OR = 4.8，95% CI：1.14-33.09，P = .05）与部分放射学缓解相关：结论：类固醇难治性肺炎会增加 NSCLC 患者的 1 年死亡率。治疗前的ILAs可能预示着纤维化相关结果的易感性，表现为部分缓解，这反过来又与缓解后的症状和残留低氧血症有关。这些发现为确定肺炎缓解后有不良后果风险的患者提供了启示。

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Long-Term Clinical, Radiological, and Mortality Outcomes Following Pneumonitis in Nonsmall Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Analysis

Aims

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.

Methods

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.

Results

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.

Conclusions

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.

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.