肿瘤患者免疫检查点抑制剂相关性肺炎的特征及临床结局分析

杨琰; 白华; 肖文文; 朱波; 王中瑜

doi:10.16016/j.2097-0927.202310097

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肿瘤患者免疫检查点抑制剂相关性肺炎的特征及临床结局分析

临床医学 | 更新时间：2026-01-09

- 肿瘤患者免疫检查点抑制剂相关性肺炎的特征及临床结局分析
- Characteristics and clinical outcomes of checkpoint inhibitor-associated pneumonia in cancer patients: a retrospective analysis of 1 084 cases
- 陆军军医大学学报 2024年46卷第15期页码：1789-1796
- 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：
  
  [王中瑜，E-mail：790040017@qq.comWANG Zhongyu, E-mail: 790040017@qq.com
- 基金信息：
  
  利益冲突声明本文作者均声明不存在利益冲突
- DOI：10.16016/j.2097-0927.202310097
  中图分类号： R563.1;R730.51;R730.6
- 收稿：2023-10-25，
  
  修回：2024-01-06，
  
  纸质出版：2024-08-15
- 稿件说明：
移动端阅览
杨琰, 白华, 肖文文, 等. 肿瘤患者免疫检查点抑制剂相关性肺炎的特征及临床结局分析[J]. 陆军军医大学学报, 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.
杨琰, 白华, 肖文文, 等. 肿瘤患者免疫检查点抑制剂相关性肺炎的特征及临床结局分析[J]. 陆军军医大学学报, 2024,46(15):1789-1796. DOI： 10.16016/j.2097-0927.202310097.

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

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

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

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(

=3.018，

=0.036)、胸部放疗史(

=2.605，

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(

=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

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

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

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

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

=3.018

=0.036) and history of chest radiotherapy (

=2.605

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 (

=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

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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