晚期非小细胞肺癌免疫相关性肺炎影响因素及预后分析  

Analysis of influencing factors and prognosis of immune associated pneumonia in advanced non-small cell lung cancer

作　　者：陈玮 吴梦瑶[1] 李亚虎 陶敏[1,2] CHEN Wei;WU Mengyao;LI Yahu;TAO Min(Department of Oncology,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu215000,China;Department of Oncology,Dushu Lake Hospital Affiliated to Soochow University,Suzhou,Jiangsu215000,China)

机构地区：[1]苏州大学附属第一医院肿瘤科,江苏苏州215000 [2]苏州大学附属独墅湖医院肿瘤科,江苏苏州215000

出　　处：《中华肿瘤防治杂志》2023年第20期1223-1229,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81772645)。

摘　　要：目的探讨Ⅳ期非小细胞肺癌(NSCLC)患者接受程序性细胞死亡蛋白-1(PD-1)/程序性细胞死亡配体-1(PD-L1)抑制剂治疗后并发免疫相关性肺炎(CIP)的影响因素,并分析预后。方法对2019-09-01-2021-05-31在苏州大学附属第一医院接受PD-1/PD-L1抑制剂治疗的83例Ⅳ期NSCLC患者临床资料进行回顾性分析。根据是否并发CIP,将患者划分为CIP组(17例)和非CIP组(66例)。计量资料组间比较采用t检验或Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验或Fisher精确检验。与发生CIP有关联的影响因素采用多因素二分类logistic回归分析。影响预后生存期的多因素分析采用Cox比例风险模型。结果共纳入83例患者,其中17例并发CIP,CIP发生的中位时间为70 d(19~703 d)。多因素logistic回归结果提示,肺部基础疾病史(OR=5.438,95%CI为1.507~19.615,P=0.010)及血清肌酸激酶(CK)≥82.80 U/L(OR=7.826,95%CI为2.037~30.066,P=0.003)与并发CIP有关联。单因素生存分析显示,CIP、鳞癌、乳酸脱氢酶(LDH)≥240 U/L或CK≥82.80 U/L患者中位总生存期(OS)较短,均P<0.05;多因素Cox回归分析提示,CIP(HR=3.477,95%CI为1.246~9.531,P=0.017)、鳞癌(HR=3.021,95%CI为1.293~7.061,P=0.011)以及血清LDH≥240 U/L(HR=3.854,95%CI为1.599~9.289,P=0.003)是影响患者生存的危险性因素。结论在接受免疫检查点抑制剂(ICIs)治疗的晚期NSCLC患者中,基线高CK以及有肺部基础疾病与并发CIP的风险增加有关联。鳞癌、免疫治疗前高LDH或治疗后并发CIP的患者预后较差。Objective To investigate the influencing factors and prognosis of checkpoint inhibitor pneumonitis(CIP)in patients with stageⅣnon-small cell lung cancer(NSCLC)after receiving programmed cell death protein-1(PD-1)/programmed cell death ligand 1(PD-L1)inhibitors.Methods The clinical data of patients with stageⅣNSCLC who received PD-1/PD-L1inhibitor treatment in the First Affiliated Hospital of Suzhou University from September 1,2019to May 31,2021were retrospectively analyzed.Patients were divided into CIP group(17cases)and non-CIP group(66cases)according to whether CIP was complicated.The t-test or Mann-Whitney Utest was used for comparison of measurement data between groups.Comparisons of categorical data between groups were performed by using the chi-square test or Fisher's exact test.Multivariate binary logistic regression analysis was used to analyze the influencing factors associated with CIP.Cox proportional hazards model was used for multivariate analysis of prognostic survival.Results A total of 83patients were enrolled,17of whom developed CIP,and the median time to onset of CIP was 70days(range:19to 703d).The results of multivariate logistic regression suggested that history of pulmonary diseases(OR=5.438,95%CI:1.507-19.615,P=0.010)and serum creatine kinase(CK)≥82.80U/L(OR=7.826,95%CI:2.037-30.066,P=0.003)were independently associated with CIP.Univariate survival analysis showed that the median overall survival(OS)of patients with CIP,squamous cell carcinoma(SCC),lactate dehydrogenase(LDH)≥240U/L or CK≥82.80U/L was significantly reduced(P<0.05).Multivariate Cox regression analysis suggested that CIP(HR=3.477,95%CI:1.246-9.531,P=0.017),SCC(HR=3.021,95%CI:1.293-7.061,P=0.011),and serum LDH≥240U/L(HR=3.854,95%CI:1.599-9.289,P=0.003)were risk factors affecting the survival of patients.Conclusions Among patients with advanced NSCLC who received ICIs,high baseline CK and previous underlying pulmonary diseases are associated with an increased risk of developing CIP.The prognosis of patients with SCC,h

关 键 词：晚期非小细胞肺癌 免疫相关性肺炎 鳞癌 肌酸激酶 乳酸脱氢酶 

分 类 号：R734.2[医药卫生—肿瘤]