免疫检查点抑制剂治疗晚期非小细胞肺癌合并COPD和ct定义的肺气肿：一项系统综述和荟萃分析

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-08-04 DOI:10.1016/j.lungcan.2025.108700

Yixiao Zhang , Jin Zhao , Zhuo Ma , Jiawen Yi , Yuan Yuan , Lu Lang , Chen Zhang , Min Zhu , Yuhui Zhang

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引用次数: 0

摘要

背景：在接受化疗的非小细胞肺癌（NSCLC）患者中，既往存在的慢性阻塞性肺疾病（COPD）和计算机断层扫描（CT）定义的肺气肿与较差的预后相关，但这些合共病对接受免疫检查点抑制剂（ICIs）治疗的患者的影响仍不清楚。方法收集截至2024年8月不同数据库中已有COPD和ct定义肺气肿的晚期非小细胞肺癌患者接受ICIs治疗的安全性和有效性结果。获得事件数、合并效应大小[优势比（OR）和风险比（HR）]和95%置信区间（ci）。结果共纳入21项研究，其中疗效研究7项，安全性研究11项，两者均纳入3项。meta分析显示，合并总有效率（ORR）和合并疾病控制率（DCR）分别为38%和62%。与先前没有COPD和ct定义的肺气肿的患者相比，ORR和DCR的合并OR分别为1.88 （95% CI, 1.45-2.44）和2.23 (95% CI, 1.67-2.98)，无异质性。COPD和ct定义的肺气肿也与更好的无进展生存（HR, 0.63 [95% CI, 0.50-0.80]）和总生存（HR, 0.59 [95% CI, 0.41-0.88]）相关。在既往存在COPD和ct定义的肺气肿患者中，任何级别和3级或更高级别的检查点抑制剂相关肺炎（CIP）的总发病率分别为20%和6%，显著高于没有这些合共病的患者(or, 1.97 [95% CI, 1.41-2.76]；或2.52 [95% ci, 1.72-3.70])。此外，大多数CIP病例（84.0%）因停止使用ICIs和/或使用皮质类固醇而改善。结论在免疫治疗时代，既往存在的COPD和ct定义的肺气肿与良好的临床疗效和增加的CIP风险相关。大多数CIP病例是可以治疗和控制的。

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Immune checkpoint inhibitors for advanced non-small cell lung cancer with preexisting COPD and CT-defined emphysema: A systematic review and meta-analysis

Background

Preexisting chronic obstructive pulmonary disease(COPD) and Computed Tomography(CT)-defined emphysema are associated with worse prognosis in patients with non-small cell lung cancer(NSCLC) receiving chemotherapy, but the impact of these comorbidities on patients undergoing immune checkpoint inhibitors(ICIs) remains largely unclear.

Methods

Studies on the safety and efficacy outcomes among advanced NSCLC with preexisting COPD and CT-defined emphysema receiving ICIs from various databases up to August 2024 were collected. The number of events, as well as pooled effect size [odds ratio(OR) and hazard ratio (HR)] and 95% confidence intervals (CIs) were obtained.

Results

A total of 21 studies (7 on efficacy, 11 on safety, and 3 on both) were included. Meta-analysis revealed the pooled overall response rate (ORR) and pooled disease control rate (DCR) were 38% and 62%, respectively. Compared to patients without preexisting COPD and CT-defined emphysema, the pooled OR for ORR and DCR was 1.88 (95% CI, 1.45–2.44) and 2.23 (95% CI, 1.67–2.98), without heterogeneity. COPD and CT-defined emphysema were also associated with better progression-free survival (HR, 0.63 [95% CI, 0.50–0.80]) and overall survival (HR, 0.59 [95% CI, 0.41–0.88]). The pooled incidences of any grade and grade 3 or higher checkpoint inhibitor-related pneumonitis (CIP) were 20% and 6% in patients with preexisting COPD and CT-defined emphysema, which was significantly higher than that in those without these comorbidities (OR, 1.97 [95% CI, 1.41–2.76]; OR, 2.52 [95% CI, 1.72–3.70]). Moreover, most cases of CIP (84.0%) improved with ICIs discontinuation and/or the administration of corticosteroids.

Conclusion

Preexisting COPD and CT-defined emphysema were associated with favorable clinical efficacy and increased risk of CIP in the immunotherapy era. Most cases of CIP are treatable and manageable.

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.