Ⅲ~Ⅳ期肺癌免疫检查点抑制剂治疗的免疫相关不良反应分析

Analysis of adverse reactions associated with immune checkpoint inhibitors therapy for stageⅢ-Ⅳlung cancer

目的探讨免疫检查点抑制剂(ICIs)治疗Ⅲ~Ⅳ期肺癌患者的免疫相关不良反应(irAEs)发生情况及安全性。方法回顾性收集并分析54例接受ICIs治疗的Ⅲ~Ⅳ期肺癌患者irAEs发生情况、危险因素及总生存期等。结果54例患者中,27例发生了irAEs,发生率为50.00%,发生中位时间为56 d。irAEs累及内分泌系统、皮肤、肺、心脏、胃肠道、肝脏、肾脏、关节等,其中25例患者发生1级或2级irAEs,2例患者发生3级或4级irAEs,1例患者由于发生心肌炎而死亡。而与未发生irAEs组相比,irAEs组的总生存期明显延长(20.27个月vs 8.50个月),差异有统计学意义(χ^(2)=8.21,P<0.05)。结论irAEs发生率较高,可累及全身各系统,多数为轻中度,严重irAEs可危及生命,但发生率不高,总体临床应用ICIs治疗安全性是可接受的。且irAEs的发生可能与预后较好相关。

Objective To explore the occurrence and safety of immune-related adverse events(irAEs)of stageⅢ-Ⅳlung cancer patients who treated with immune checkpoint inhibitors(ICIs).Methods A retrospective study of 54 pa-tients with stageⅢ-Ⅳlung cancer who received ICIs treatment was performed.Clinical data including the occurrence of irAEs,risk factors of irAEs and overall survival were recorded and analyzed.Results Among 54 patients,27(50.00%)de-veloped irAEs,the median time was 56 days.The irAEs affect organs including the endocrine system,skin,lung,heart,in-testine,liver,kidney,and joints.Among them,25 patients had irAEs of grade 1 or 2,2 patients had irAEs of grade 3 or 4,1 patient died of myocarditis.Patients who developed irAEs experienced an overall survival(OS)benefit when compared to patients who did not develop irAEs(20.27 months vs 8.50 months)(χ^(2)=8.21,P<0.05).Conclusion The incidence of irAEs is relatively high and irAEs can affect many systems,most of which are mild to moderate.Severe irAEs can be life-threat-ening,but the incidence is low.The safety of ICIs therapy is acceptable.And irAEs may be associated with better prognosis.