血清克雷布斯·冯·登·伦根-6和表面活性蛋白- d水平在免疫检查点抑制剂诱导的免疫相关性肺炎诊断中的应用

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2025-02-18 DOI:10.1016/j.resinv.2025.02.005

Shogo Nakai , Masato Karayama , Yusuke Inoue , Hideki Yasui , Hironao Hozumi , Yuzo Suzuki , Kazuki Furuhashi , Tomoyuki Fujisawa , Noriyuki Enomoto , Satoshi Funayama , Shintaro Ichikawa , Satoshi Goshima , Naoki Inui , Takafumi Suda

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引用次数: 0

摘要

免疫相关性肺炎（irP）是一种严重的免疫相关不良事件，可在使用免疫检查点抑制剂（ICIs）治疗后发生；准确的监测和早期诊断至关重要。血清Krebs von den Lungen-6 （KL-6）和表面活性蛋白d （SP-D）用于诊断和监测各种类型间质性肺疾病的疾病活动性。本研究评估了KL-6和SP-D在接受ici的癌症患者中诊断irP的有效性。患者和方法本回顾性观察性研究纳入了2014年9月至2023年10月接受2个周期以上ICIs治疗的癌症患者。采用受试者工作特征（ROC）分析评估KL-6和SP-D的诊断价值。结果724例癌症患者中，631例纳入分析，64例发生irP。ROC分析显示，KL-6和SP-D的曲线下面积分别为0.803和0.845。血清KL-6≥500 U/mL诊断irP的敏感性为65.6%，特异性为83.4%，SP-D≥110 ng/mL诊断irP的敏感性为66.7%，特异性为88.6%。结合KL-6≥500 U/mL和SP-D≥110 ng/mL，特异性为96.6%，敏感性为46.7%。结合KL-6≥500 U/mL或SP-D≥110 ng/mL，敏感性为85.0%，特异性为75.5%。SP-D水平与irP严重程度显著相关，而KL-6水平无显著相关性。结论血清KL-6和SP-D可用于诊断肿瘤接受ICIs患者的irP。

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Utility of serum Krebs von den Lungen-6 and surfactant protein-D levels for the diagnosis of immune checkpoint inhibitor-induced immune-related pneumonitis

Background

Immune-related pneumonitis (irP) is a severe immune-related adverse event that can occur after treatment with immune checkpoint inhibitors (ICIs); accurate monitoring and early diagnosis are crucial. Serum Krebs von den Lungen-6 (KL-6) and surfactant protein-D (SP-D) are used to diagnose and monitor the disease activity of various types of interstitial lung disease. This study evaluated the usefulness of KL-6 and SP-D for diagnosing irP in cancer patients receiving ICIs.

Patients and methods

This retrospective observational study included cancer patients treated with more than two cycles of ICIs from September 2014 to October 2023. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic utility of KL-6 and SP-D.

Results

Of the 724 cancer patients, 631 were included in the analysis, and 64 developed irP. The ROC analysis showed that KL-6 and SP-D had areas under the curve of 0.803 and 0.845, respectively. Serum KL-6 ≥ 500 U/mL had a sensitivity of 65.6% and a specificity of 83.4% for the diagnosis of irP, while SP-D ≥ 110 ng/mL had a sensitivity of 66.7% and a specificity of 88.6%. Combining both KL-6 ≥ 500 U/mL and SP-D ≥ 110 ng/mL resulted in a specificity of 96.6%, with a sensitivity of 46.7%. Combining either KL-6 ≥ 500 U/mL or SP-D ≥ 110 ng/mL resulted in a sensitivity of 85.0%, with a specificity of 75.5%. SP-D levels were significantly associated with irP severity, while KL-6 levels were not.