肺癌患者免疫检查点抑制剂相关肺炎的危险因素及临床特点

Clinical characteristics and risk factors for immune checkpoint inhibitor-related pneumonitis in lung cancer patients

目的:分析肺癌患者免疫检查点抑制剂(ICIs)相关肺炎(CIP)的危险因素及临床特点。方法:选择2021年7月至2022年12月在南京大学医学院附属金陵医院接受ICIs治疗的肺癌患者为研究对象,根据是否发生CIP分为CIP组和非CIP组,绘制受试者工作特征(ROC)曲线确定连续变量预测CIP发生的最佳临界值,采用多因素Logistic回归分析肺癌患者发生CIP的危险因素,多因素Cox回归分析CIP患者无进展生存期(PFS)的影响因素。结果:纳入的307例接受ICIs治疗的肺癌患者中,38例(12.38%)患者发生了CIP,其中1例患者出现与CIP相关的死亡。多因素Logistic回归分析结果显示,慢性阻塞性肺疾病、低基线淋巴细胞计数(临界值1.265×10^(9) L^(-1))和高基线嗜酸粒细胞计数(临界值0.245×10^(9) L^(-1))是肺癌患者发生CIP的独立危险因素(P<0.05)。多因素Cox回归显示,吸烟史和严重程度是CIP患者PFS的影响因素(P<0.05)。结论:慢性阻塞性肺疾病、低基线淋巴细胞计数、高基线嗜酸粒细胞计数与肺癌患者CIP风险增加独立相关。有吸烟史和临床分级高的CIP患者免疫疗效不佳。

Objective:To retrospectively analyze the clinical characteristics and risk factors of immune checkpoint inhibitor-related pneumonitis(CIP)in lung cancer patients.Methods:Lung cancer patients who were treated with immune checkpoint inhibitors(ICIs)in Jinling Hospital from July 2021 to December 2022 were selected for the study.They were divided into CIP group and non-CIP group according to whether or not CIP occurred.The receiver operating characteristic(ROC)curve determined the optimal cut-off value of continuous variables for predicting CIP in lung cancer patients.The risk factors for CIP in lung cancer patients were analyzed by multivariate Logistic regression.Multivariate Cox regression was used to analyze the factors affecting progression-free survival(PFS)in patients with CIP.Results:Of the 307 lung cancer patients treated with ICIs included,38(12.38%)patients developed CIP,and one of them experienced a CIP-related death.The results of multivariate Logistic regression analysis showed that chronic obstructive pulmonary disease,low baseline lymphocyte counts and high baseline eosinophil counts were independent risk factors for the development of CIP in lung cancer patients(P<0.05).In patients with CIP,multivariate Cox regression showed that smoking history and severe CIP were influential factors for PFS(P<0.05).Conclusion:Chronic obstructive pulmonary disease,low baseline lymphocyte counts and high baseline eosinophil counts are independently associated with an increased risk of CIP in patients with lung cancer.CIP patients with a history of smoking and high clonical grade have poor immunotherapy outcomes.