恶性肿瘤患者肺间质异常与细胞毒性药物引起的肺炎的关系。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2025-02-01 DOI:10.1016/j.rmed.2024.107924

Kyohei Oishi , Hironao Hozumi , Nobuko Yoshizawa , Shintaro Ichikawa , Yusuke Inoue , Hideki Yasui , Yuzo Suzuki , Masato Karayama , Kazuki Furuhashi , Noriyuki Enomoto , Tomoyuki Fujisawa , Satoshi Goshima , Naoki Inui , Takafumi Suda

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引用次数: 0

摘要

背景与目的：间质性肺异常（ILA）与多种疾病，包括药物相关性肺炎（DRP）之间的关系已被报道。然而，在接受基于细胞毒性药物的化疗（恶性肿瘤的标准治疗方法之一）的患者中，ILA的存在与发生DRP的关系尚不清楚。这需要紧急调查。方法：我们纳入了连续诊断为恶性肿瘤并接受细胞毒性药物治疗的患者（含/不含免疫检查点抑制剂（ICIs））。我们分别使用Gray's方法和多变量Fine-Gray亚分布风险分析来评估DRP的累积发生率（不良事件等级≥3的常用术语标准）和ILA与DRP发展之间的关系。结果：786例患者中，58例（7.3%）表现为ILA。ILA患者年龄较大，以男性为主，与没有ILA的患者相比，吸烟史较高。有/没有ICIs的ILA患者的90天累积细胞毒性药物诱导DRP发生率显著高于没有ICIs的患者（6.0% vs. 1.2%, p = 0.006）。经年龄、性别和吸烟史校正的多因素分析显示，ILA与细胞毒性药物合并/不合并ICIs（风险比[HR] 3.11, 95%可信区间[CI]: 1.06-9.14, p = 0.039）和单独使用细胞毒性药物（风险比[HR]: 5.53, 95% CI: 1.55-19.7, p = 0.008）导致DRP发生的风险增加相关。结论：ILA的存在与接受细胞毒性药物化疗的患者发生DRP的风险增加有关。因此，建议在确定包括细胞毒性药物的化疗方案之前评估ILA的存在。

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Association of interstitial lung abnormalities with cytotoxic agent-induced pneumonitis in patients with malignancy

Background and objective

The association between interstitial lung abnormalities (ILA) and various conditions and diseases, including drug-related pneumonitis (DRP), has been reported. However, the association of the presence of ILA with developing DRP in patients undergoing cytotoxic agent-based chemotherapy, one of the standard treatments for malignancies, remains unclear. This warrants urgent investigation.

Methods

We included consecutive patients diagnosed with malignancy and treated with cytotoxic agents with/without immune checkpoint inhibitors (ICIs). We used Gray's method and multivariate Fine-Gray sub-distribution hazards analysis to evaluate the cumulative incidence of DRP (common terminology criteria for adverse events grade of ≥3) and the association between ILA and DRP development, respectively.

Results

Among 786 patients, 58 (7.3 %) demonstrated ILA. Patients with ILA were older, predominantly male, and reported a higher smoking history compared to those without ILA. The 90-day cumulative incidence of cytotoxic agent-induced DRP with/without ICIs was significantly higher in patients with ILA than in those without ILA (6.0 % vs. 1.2 %, p = 0.006). Multivariate analysis, adjusted for age, sex, and smoking history, revealed that ILA was associated with an increased risk of developing DRP due to cytotoxic agents with/without ICIs (hazard ratio [HR] 3.11, 95 % confidence interval [CI]: 1.06–9.14, p = 0.039) and cytotoxic agents alone (HR: 5.53, 95 % CI: 1.55–19.7, p = 0.008).

Conclusions

The presence of ILA is associated with an increased risk of developing DRP in patients undergoing cytotoxic agent-based chemotherapy. Therefore, evaluating the presence of ILA before determining chemotherapy regimens that include cytotoxic agents is recommended.

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.