老年与非老年肺癌患者发生免疫检查点抑制剂相关肺炎的临床特征比较  

Comparison of clinical characteristics of immune checkpoint inhibitor associated pneumonia between elderly and non-elderly lung cancer patients

作　　者：王艳[1] 许小毛[1] 陈起航[2] 方芳[3] 李琳[1] 柯会星[1] Wang Yan;Xu Xiaomao;Chen Qihang;Fang Fang;Li Lin;Ke Huixing(Department of Respiratory and Critical Care Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]北京医院呼吸与危重症医学科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院放射科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [3]北京医院病理科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2025年第1期34-39,共6页Chinese Journal of Geriatrics

摘　　要：目的总结并比较老年与非老年肺癌患者应用免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)发生免疫检查点抑制剂相关肺炎(checkpoint inhibitor pneumonitis,CIP)的临床特征。方法回顾性分析北京医院呼吸与危重症医学科、肿瘤内科自2016年5月至2024年4月接受ICIs治疗后发生CIP的61例患者临床资料,并对比分析≥65岁和<65岁两组患者的临床特征。结果纳入的61例患者中,<65岁组26例,年龄39~64(56.3±5.6)岁,其临床分级分别为:5例G1、12例G2、7例G3、2例G4,共计12例患者完成支气管镜检查、17例患者发生CIP后应用激素治疗、20例患者因发生CIP永久停用免疫治疗、1例患者CIP治疗好转后继续用药,无患者因CIP原因死亡;≥65岁组共计35例,年龄65~83(71.9±4.9)岁,其临床分级分别为:4例G1、22例G2、5例G3、4例G4,共计21例患者完成支气管镜检查、31例患者发生CIP后应用激素治疗、30例患者因发生CIP永久停用免疫治疗、1例患者CIP治疗好转后继续用药,无患者因CIP原因死亡。与<65岁组患者比较,≥65岁组患者CIP发生的中位时间更短[2(1,4)个月比5.5(2,8)个月,Z=-3.231,P=0.001],发生CIP后应用激素治疗比例更高[88.57%(31例)比65.38%(17例),χ^(2)=4.704、P=0.030],两组患者发生CIP症状及胸部影像学特征比较的差异均无统计学意义(均P>0.05)。结论≥65岁老年肺癌患者应用ICIs后发生CIP的中位时间更短,早期识别诊断后应用激素治疗的临床结局与<65岁组相比无显著性差异。Objective To summarize and compare the clinical characteristics of immune checkpoint inhibitor-associated pneumonia(CIP)in elderly and non-elderly lung cancer patients treated with immune checkpoint inhibitors(ICIs).MethodsWe conducted a retrospective analysis of the clinical data from 61 patients who developed CIP following ICIs treatment in the Respiratory and Critical Care Medicine Department and the Oncology Department of Beijing Hospital from May 2016 to April 2024.The clinical characteristics of patients aged 65 years and older were compared with those of patients younger than 65 years.ResultsA total of 61 patients were included in the study,with 26 patients in the group aged<65 years[aged 39-64(56.3±5.6)years].Within this group,the clinical grades were distributed as follows:5 patients in grade 1(G1),12 in grade 2(G2),7 in grade 3(G3),and 2 in grade 4(G4).Twelve patients underwent bronchoscopy,while 17 patients received corticosteroid therapy after developing CIP.Additionally,20 patients permanently discontinued immunotherapy due to CIP.Notably,one patient showed improvement in CIP following treatment,which allowed for the continuation of ICIs.Importantly,no patients in this group experienced mortality due to CIP.In the group aged≥65 years[aged 65-83(71.9±4.9)years],there were 35 patients,categorized as follows:4 in G1,22 in G2,5 in G3,and 4 in G4.Twenty-one patients underwent bronchoscopy,31 received corticosteroid therapy after developing CIP,and 30 patients permanently discontinued immunotherapy due to CIP.Similarly,one patient in this group demonstrated improvement in CIP following treatment,which permitted the continuation of ICIs.Importantly,no patients in this group experienced mortality due to CIP.Compared to patients aged<65 years,those aged≥65 years experienced a shorter median time to the occurrence of CIP,with a median of 2(1,4)months versus 5.5(2,8)months for the younger group(Z=-3.231,P=0.001).Furthermore,a higher proportion of patients aged≥65 years received corticosteroid therapy af

关 键 词：肺肿瘤 免疫检查点抑制剂 肺炎 

分 类 号：R734.2[医药卫生—肿瘤]