肺癌重度(3~4级)免疫检查点抑制剂相关肺炎CT特征

CT Imaging Characteristics of Severe(Grade 3-4)Immune Checkpoint Inhibitor-Related Pneumonitis in Lung Cancer

目的观察肺癌患者重度免疫检查点抑制剂相关肺炎(CIP)的临床及CT特点。资料与方法回顾性收集2019年9月1日—2022年3月31日在西安国际医学中心医院接受免疫检查点抑制剂(PD-1/PD-L1抑制剂)治疗的174例肺癌患者,分析重度CIP患者的临床及影像特点。结果共23例患者符合重度CIP诊断。其中,22例男性,15例发病年龄<65岁,17例有基础肺病史,16例有放化疗和其他治疗史,21例有联合放化疗史;免疫检查点抑制剂用药开始至发生CIP的中位时间为128(74,348)d;19例为非小细胞癌;16例CIP发生于右肺癌,15例出现肿瘤中央气道侵犯,14例影像学特征为弥漫性肺泡损伤/急性间质性肺炎模式,20例于随访期间死亡。结论重度CIP可能好发于男性、有基础病史、放化疗治疗史的肺癌患者,其临床表现多样,主要影像学特征为弥漫性肺泡损伤/急性间质性肺炎模式,预后较差。

Purpose To observe the clinical and CT features of severe immune checkpoint inhibitor-related pneumonitis(CIP)in lung cancer patients.Materials and Methods A total of 174 patients with lung cancer who received immune checkpoint inhibitor(PD-1/PD-L1 inhibitors)in Xi'an International Medical Center Hospital from September 1,2019 to March 31,2022 were retrospectively collected.Clinical and imaging features of patients with severe CIP were analyzed.Results There were 23 patients who met the diagnostic criteria of severe CIP.Among them,22 were male patients,15 were younger(<65 years old),17 had a history of underlying lung disease,16 had a history of chemoradiotherapy and other treatments,and 21 had a history of combined radiotherapy and chemoradiotherapy.The median time from the initiation of immune checkpoint inhibitor to CIP was 128(74,348)days.19 patients were non-small cell carcinoma.CIP occurred in 16 patients with right lung cancer,15 had tumor central airway invasion,14 had radiographic features of diffuse alveolar injury/acute interstitial pneumonia pattern,and 20 died during follow-up.Conclusion Severe CIP is likely to occur in male lung cancer patients with a history of basic medical history and radiotherapy and chemotherapy.The clinical manifestations are varied,and the main imaging features are diffuse alveolar injury/acute interstitial pneumonia pattern,and the prognosis is poor.