Characteristics and clinical outcomes of checkpoint inhibitor-associated pneumonia in cancer patients: a retrospective analysis of 1 084 cases
- Journal of Army Medical University Vol. 46, Issue 15, Pages: 1789-1796(2024)
- 作者机构：
1.610041 成都，西藏自治区人民政府驻成都办事处医院药剂科
2.401135 重庆，重庆理工大学药学与生物工程学院
3.400084 重庆，重庆市大渡口区人民医院药剂科
4.400037 重庆，陆军军医大学(第三军医大学)第二附属医院肿瘤科
- 作者简介：
- 基金信息：
DOI：10.16016/j.2097-0927.202310097
CLC： R563.1;R730.51;R730.6Received：25 October 2023，
Revised：2024-01-06，
Published：15 August 2024
- 稿件说明：
移动端阅览
Yan YANG, Hua BAI, Wenwen XIAO, et al. Characteristics and clinical outcomes of checkpoint inhibitor-associated pneumonia in cancer patients: a retrospective analysis of 1 084 cases[J]. Journal of Army Medical University, 2024, 46(15): 1789-1796.
Yan YANG, Hua BAI, Wenwen XIAO, et al. Characteristics and clinical outcomes of checkpoint inhibitor-associated pneumonia in cancer patients: a retrospective analysis of 1 084 cases[J]. Journal of Army Medical University, 2024, 46(15): 1789-1796. DOI： 10.16016/j.2097-0927.202310097.
摘要
目的
2
研究接受PD-1/PD-L1抑制剂治疗的肿瘤患者中免疫检查点抑制剂相关性肺炎(checkpoint inhibitor-related pneumonitis，CIP)的发生率、危险因素、治疗转归以及其他临床结局。
方法
2
回顾性分析2019-2021年在陆军军医大学第二附属医院肿瘤科接受PD-1/PD-L1抑制剂治疗患者1 084例的临床资料。根据患者是否发生CIP分为非CIP组(998例)和CIP组(86例)，将发生CIP的患者分为G1~G4级，其中G1~G2级归为低级别CIP组(69例)，G3~G4级归为高级别CIP组(17例)。利用卡方检验、二元Logistics回归、Kaplan-Meier生存分析等方法，总结CIP的发病率、危险因素、治疗转归以及与免疫治疗效果和无进展生存期(PFS)的关系。
结果
2
CIP发生率为7.93%(86/1 084)，其中高级别CIP的发生率为1.57%(17/1 084)，CIP的致死率为0.09%(1/1 084)。二元Logistics分析结果显示，影响CIP发生的独立危险因素为慢性阻塞性肺疾病史(
OR
=3.018，
P
=0.036)、胸部放疗史(
OR
=2.605，
P
<
0.001)；而年龄≥65岁患者高级别CIP发生率显著高于年龄
<
65岁患者(
P
=0.021)。CIP组与非CIP组患者的肿瘤客观缓解率(ORR)、疾病控制率(DCR)、PFS差异均无统计学意义。86例CIP患者中有50例(58.14%)停止免疫治疗，36例(41.86%)继续或者重启免疫治疗；有1例(1.16%)患者发生呼吸衰竭死亡，其余患者经过停药、激素治疗、免疫抑制剂治疗等均得到缓解。
结论
2
有慢性阻塞性肺疾病病史或接受过胸部放疗的肿瘤患者接受PD-1/PD-L1治疗后CIP发生率较高；高龄患者更容易发生高级别CIP。CIP患者经过积极治疗可以获得良好的预后，并且部分低级别CIP患者可以重启免疫治疗。
Abstract
Objective
2
To investigate the incidence
risk factors
treatment outcomes
and other clinical outcomes of checkpoint inhibitor-related pneumonitis (CIP) in cancer patients treated with PD-1/PD-L1 inhibitors.
Methods
2
Clinical data of 1 084 cancer patients who received treatment with PD-1/PD-L1 inhibitors from 2019 to 2021 in Department of Oncology of the Second Affiliated Hospital of Army Medical University were collected and then retrospectively analyzed. The patients were divided into a non-CIP group (998 cases) and a CIP group (86 cases)
and those from the latter group were further divided into G1~G4 grades
of which G1~G2 grades were classified as low-grade CIP subgroup (69 cases) and G3~G4 grades as high-grade CIP subgroup (17 cases).
Chi
-square test
binary logistic regression and Kaplan-Meier survival analysis were used to summarize the incidence
risk factors
treatment outcome of CIP and its relationship with immune efficacy and progression-free survival (PFS).
Results
2
The incidence of CIP was 7.93% (86/1 084) in the cohort
the rate of high-grade CIP was 1.57% (17/1 084)
and the rate of mortality was 0.09% (1/1 084). Binary logistic regression analysis showed that history of chronic obstructive pulmonary disease (COPD
OR
=3.018
P
=0.036) and history of chest radiotherapy (
OR
=2.605
P
<
0.001) were independent risk factors f
or CIP. The patients with an age of ≥65 years had an obviously higher incidence of high-grade CIP than those with younger age (
P
=0.021). There were no statistical differences in objective remission rate (ORR)
disease control rate (DCR) and PFS between the non-CIP group and the CIP group. Out of the 86 CIP patients
50(58.14%) stopped immunotherapy
the other 36 (41.86%) continued or restarted immunotherapy. One (1.16%) patient died of respiratory failure
and the remaining patients were relieved after drug withdrawal
hormone therapy
immunosuppressive therapy
etc
.
Conclusion
2
The cancer patients with history of COPD or chest radiotherapy have a higher incidence of CIP after PD-1/PD-L1 treatment. Patients with advanced age are prone to high-grade CIP. Most CIP patients can achieve good outcomes after active treatment
and some with low-grade CIP can restart immunotherapy.
关键词
Keywords
references
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