质子泵抑制剂对非小细胞肺癌免疫检查点抑制剂疗效的影响

Effect of Proton Pump Inhibitors on the Efficacy of Immune Checkpoint Inhibitors in Patients with Non-small Cell Lung Cancer

目的探讨质子泵抑制剂(PPIs)对接受免疫检查点抑制剂(ICIs)治疗的非小细胞肺癌(NSCLC)患者疗效的影响。方法选择2020年1月至2022年10月就诊于郑州大学第一附属医院的NSCLC患者200例为研究对象,根据入组前30d是否有PPIs服药史(至少连续服用7 d)将其随机分为抑酸组和非抑酸组,每组100例,两组患者均根据病情需要接受ICIs抗肿瘤治疗。收集患者性别、年龄、吸烟史、肺癌家族史、病理及临床数据、治疗方案等基线数据。自患者接受ICIs治疗开始随访12个月,比较两组疗效、无病生存率、总生存率和药物不良反应发生情况。结果非抑酸组总有效率(72.00%)高于抑酸组(53.00%)(P<0.05)。多因素COX回归显示,服用PPIs可显著降低NSCLC患者随访期间的无病生存率(HR:0.428,95%CI:0.282~0.650)和总生存率(HR:0.538,95%CI:0.304~0.953)。两组患者经ICIs治疗后主要不良反应发生率比较,差异均无统计学意义(P>0.05)。结论服用PPIs可能对ICIs治疗NSCLC的疗效产生负面影响,并可能导致患者预后不良。

Objective To explore the effect of proton pump inhibitors(PPIs)on the efficacy of immune checkpoint inhibitors(ICIs)in patients with non-small cell lung cancer(NSCLC).Methods A total of 200 NSCLC patients who were consecutively selected and met the inclusion and exclusion criteria from January 2020 to October 2022 at the First Affiliated Hospital of Zhengzhou University were enrolled in this study.Patients with a history of PPIs use within 30 days prior to consultation were designated as the acid suppression group(n=100),while those without a history of PPIs use were designated as the non-acid suppression group(n=100).All patients received ICIs anti-tumor treatment as required by their clinical condition.Baseline data such as gender,age,smoking history,family history of lung cancer,pathological and clinical data,and treatment regimens were collected from the patients'medical records.Patients were followed up for 12 months from the start of ICIs treatment,during which disease progression,disease-free survival,overall survival and adverse drug reactions were recorded.Results The total effective rate was higher in the non-acid-suppressed group(72.00%)than that in the acid-suppressed group(53.00%)(P<0.05).Multivariate COX regression analysis revealed that the use of PPIs significantly reduced the disease-free survival rate(HR:0.428,95%CI:0.282-0.650)and overall survival rate(HR:0.538,95%CI:0.304-0.953)of NSCLC patients during the follow-up period.There was no statistically significant difference in major adverse reactions after ICIs treatment between the two groups of patients(P>0.05).Conclusion Taking PPIs may have a negative effect on the efficacy of ICIs treatment in NSCLC,and may lead to poorer prognosis of patients.