肺癌合并免疫检查点抑制剂相关肺炎的临床特征和预后分析

Clinical features and prognosis of immune checkpoint inhibitor⁃related pneumonitis in lung cancer

目的:总结分析肺癌合并免疫检查点抑制剂相关肺炎(checkpoint inhibitor pneumonitis,CIP)的临床特征和预后。方法:回顾性收集2018年9月—2022年9月在南京医科大学第一附属医院接受免疫检查点抑制剂(immune checkpoint inhibitor,ICI)治疗后发生CIP的肺癌患者的临床资料,对基线特征、临床特征及治疗情况分析描述,对预后进行生存分析。结果:共纳入75例患者,男71例,女4例,年龄(66.7±7.6)岁。发病时间为接受ICI治疗后4~1 054 d。60.0%的患者基线存在肺气肿,36.0%存在肺间质异常(interstitial lung abnormalities,ILA)/间质性肺病(interstitial lung disease,ILD)。影像学表现为机化性肺炎(organizing pneumonia,OP)型、非特异性间质性肺炎(nonspecific interstitial pneumonia,NSIP)型、急性间质性肺炎(acute interstitial pneumonia,AIP)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)型和其他类型的CIP患者分别有36例(48.0%)、28例(37.3%)、6例(8.0%)和5例(6.7%)。基线是否存在ILA/ILD和CIP是否表现为AIP/ARDS型的患者生存情况均存在明显差异(P <0.05)。结论:接受ICI治疗前存在ILA/ILD,以及CIP影像学表现为AIP/ARDS型的肺癌合并CIP患者预后较差。

Objective:To analyze the clinical features and prognosis of immune checkpoint inhibitor-related pneumonitis(CIP)in lung cancer.Methods:Clinical data of lung cancer patients who developed CIP after receiving immune checkpoint inhibitor(ICI)treatment at the First Affiliated Hospital of Nanjing Medical University from September 2018 to September 2022 were retrospectively collected.Baseline characteristics,clinical features,treatment conditions were analyzed and described,and survival analysis was conducted.Results:A total of 75 patients were included,with 71 males and 4 females,with a mean age of(66.7±7.6)years.The onset time was 4 to 1054 days after receiving ICI treatment.60.0%of patients had pre-existing emphysema at baseline,and 36.0%had interstitial lung abnormalities(ILA)/interstitial lung disease(ILD).Radiological manifestations included organizing pneumonia(OP)type,nonspecific interstitial pneumonia(NSIP)type,acute interstitial pneumonia(AIP)/acute respiratory distress syndrome(ARDS)type,and other types,with 36 cases(48.0%),28 cases(37.3%),6 cases(8.0%),and 5 cases(6.7%),respectively.There were significant differences in survival between patients with pre-existing ILA/ILD at baseline and those with CIP manifested as AIP/ARDS type(P<0.05).Conclusion:Lung cancer patients with pre-existing ILA/ILD before receiving ICI treatment and CIP manifested as AIP/ARDS type have a poorer prognosis.