免疫检查点抑制剂联合化疗改善中晚期肺癌患者肺通气功能和弥散功能  

Neoadjuvant immune checkpoint inhibitor therapy and chemotherapy improve pulmonary ventilation and diffusion function in patients with lung cancer

作　　者：包婺安[1] 周霞[1] 顾飞英[1] 林娟[1] 李斌[1] BAO Wu’an;ZHOU Xia;GU Feiying;LIN Juan;LI Bin(Zhejiang Cancer Hospital,Hangzhou Institute of Medicine,Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院中国科学院杭州医学研究所,浙江杭州310022

出　　处：《浙江大学学报（医学版）》2023年第5期588-593,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省中医药科学研究基金(2021ZA022);浙江省医药卫生科技计划(2020KY469)。

摘　　要：目的:探讨免疫检查点抑制剂(ICI)联合化疗新辅助治疗对肺癌患者肺通气功能和弥散功能的影响。方法:纳入2021年10月到2022年7月就诊于浙江省肿瘤医院,且新诊断肺癌(分期Ⅱa~Ⅲb)、接受新辅助ICI联合化疗治疗两个疗程、ICI治疗前后均完成肺通气功能和弥散功能检查的患者。采集人口统计学信息、病灶大小与位置、治疗药物、治疗前后肺通气功能和弥散功能结果以及肿瘤退缩情况。通过配对t检验和秩和检验寻找通气功能和弥散功能中存在治疗前后差异的参数,并通过多元线性Lasso回归和岭回归筛选可能影响治疗后肺功能变化的因素。结果:共纳入52例受试者,其中男性50例(96.15%),中位年龄67岁,鳞癌43例(82.69%)。36例(69.23%)患者新辅助治疗后肿瘤病灶出现了缓解(长短径和减少30%以上)。ICI治疗后,肺通气功能中吸气肺活量和流量容积环呼气曲线下面积较基线改善(均P<0.05);弥散功能中肺总量较基线改善(P<0.05),用力肺活量和第一秒用力呼吸量有升高趋势。多元线性Lasso回归和岭回归分析结果显示,基线吸气肺活量会对吸气肺活量改善度产生显著的负向影响(Beta值=-0.435,t=-2.968,P<0.01),基线肺总量会对肺总量改善度产生显著的负向影响(Beta值=-0.266,t=-2.474,P<0.05),梗阻性肺炎改善也有利于肺总量改善(Beta值=0.308,t=2.443,P<0.05)。结论:新辅助ICI联合化疗对肺癌患者肺通气功能和弥散功能有积极影响,基线通气和弥散功能越差,ICI新辅助治疗后改善越明显。Objective:To investigate changes of pulmonary ventilation function and diffusion function in lung cancer patients after neoadjuvant immune checkpoint inhibitors(ICIs)therapy combined with chemotherapy treatment.Methods:Patients with newly diagnosed lung cancer(Ⅱa-Ⅲb)admitted to Zhejiang Cancer Hospital from October 2021 to July 2022,who received ICIs combined with chemotherapy for more than two courses were enrolled.Patients underwent pulmonary ventilation function and diffusion function assessments before and after treatment.The demographic information,sizes and locations of cancer lesions,doses and duration of ICIs used,pulmonary function results before and after treatment,and the tumor regression were documented.The changes of pulmonary function parameters before and after the treatment were analyzed with paired t test and Wilcoxon rank-sum test.The factors influencing the pulmonary function changes were analyzed by multiple linear Lasso regression and ridge regression.Results:Among the 52 patients,50 cases were males(96.15%)and 43 cases were squamous carcinoma(82.69%).The medium age of the patients was 67 years.After neoadjuvant therapy,36 patients(69.23%)showed remission of tumor lesions.After treatment,the parameters of pulmonary ventilation inspiratory vital capacity(IVC)and the area under the expiratory flow-volume curve(AREAex),and the parameter of pulmonary diffusion total lung capacity increased compared with the baseline(all P<0.05).Forced vital capacity(FVC)and forced expiratory volume in first second(FEV1)also showed an increasing trend.Multivariate linear Lasso regression and ridge regression showed that baseline IVC had a significant negative effect on IVC improvement(Beta=-0.435,t=-2.968,P<0.01),baseline TLC had a significant negative effect on the improvement of TLC(Beta=-0.266,t=-2.474,P<0.05),and the remission of obstructive pneumonia favored the improvement of TLC(Beta=0.308,t=2.443,P<0.05).Conclusion:After ICIs neoadjuvant treatment combined with chemotherapy,the lung ventilation and dif

关 键 词：肺癌 免疫检查点抑制剂 肺通气功能 肺弥散功能 新辅助治疗 

分 类 号：R734[医药卫生—肿瘤]