肺间质异常对免疫治疗联合化疗的非小细胞肺癌患者预后影响研究

The impact of interstitial lung abnormalities on prognosis in patients with non-small cell lung cancer treated with immunotherapy combined with chemotherapy

    摘要
  • 摘要:
    目的 讨论肺间质异常（interstitial lung abnormalities，ILA）对接受免疫治疗联合化疗的非小细胞肺癌（non-small cell lung cancer，NSCLC）患者的免疫检查点抑制剂相关肺炎（checkpoint inhibitor-related pneumonitis，CIP）发生风险及生存预后的影响。
    方法 选取2019年6月至2023年6月于兰州大学第一医院接受免疫治疗联合化疗的165例NSCLC患者临床及影像资料。根据基线高分辨率CT评估ILA状态，比较治疗前存在与不存在ILA的患者的临床特征，采用逻辑回归分析CIP风险因素，用Kaplan-Meier分析及Cox比例回归分析评估ILA对NSCLC患者无进展生存期（progression-free survival，PFS）与总生存期（overall survival，OS）的影响，使用Log-rank检验分析组间生存差异。
    结果 165例患者中，42例（25.5%）基线存在ILA。基线存在ILA会增加发生CIP的风险（OR=2.808，95%CI：1.167～6.755，P=0.021），其中胸膜下非纤维化型ILA（OR=4.810，95%CI：1.729～13.382，P=0.003）与磨玻璃影（OR=4.398，95%CI：1.536～12.594，P=0.006）与CIP的发生显著相关。Kaplan-Meier分析显示，基线存在ILA患者的中位PFS（198天vs. 354天，Log-rank P=0.022）和OS（359天vs. 480天，Log-rank P=0.010）均显著缩短。Cox比例多因素分析显示ILA是PFS（HR=2.140， 95%CI：1.138～4.021，P=0.018）和OS（HR=2.276，95%CI：1.196～4.332，P=0.012）的独立不良预后因素。
    结论 基线存在ILA的NSCLC患者接受免疫联合化疗后CIP发生风险较高，生存预后更差。表现为胸膜下非纤维化型和磨玻璃影的ILA患者与更高的CIP发生风险存在关联。建议在治疗前对患者进行ILA的系统筛查与风险分层，以辅助制定晚期NSCLC患者的个体化治疗决策。

     

    Abstract:
    Objective  This study investigated the impact of interstitial lung abnormalities (ILA) on the risk and prognosis of immune checkpoint inhibitor–related pneumonitis (CIP) in patients with non-small cell lung cancer (NSCLC) receiving combination immunotherapy and chemotherapy.
    Methods  This study retrospectively reviewed the clinical and imaging data of 165 patients with NSCLC who received combination immunotherapy and chemotherapy at The First Hospital of Lanzhou University from June 2019 to June 2023. Clinical characteristics were compared between patients with and without ILA pre-treatment. Logistic regression analysis was employed to identify risk factors for CIP. The Kaplan–Meier method and Cox proportional hazards regression analysis were applied to evaluate the impact of ILA on progression-free survival (PFS) and overall survival (OS). Survival differences between groups were compared using the Log-rank test.
    Results Among the 165 patients, 42 (25.5%) presented with ILA at baseline. Baseline ILA was independently associated with CIP (odds ratio OR=2.808, 95% confidence intervals CI: 1.167-6.755, P=0.021). Additionally, both subpleural non-fibrotic ILA (OR=4.810, 95%CI: 1.729-13.382, P=0.003) and ground-glass opacity (OR=4.398, 95%CI: 1.536-12.594, P=0.006) were significantly associated with CIP. Kaplan-Meier analysis demonstrated that patients with baseline ILA had significantly short median PFS (198 d vs. 354 d, Log-rank P=0.022) and OS (359 d vs. 480 d, Log-rank P=0.010). Cox proportional hazards regression analysis confirmed that ILA served as an independent adverse prognostic factor for PFS (hazard ratio HR=2.140, 95%CI: 1.138-4.021, P=0.018) and OS (HR=2.276, 95%CI: 1.196-4.332, P=0.012).
    Conclusions Patients with NSCLC with baseline ILA are at increased risk of developing CIP and experiencing worse survival outcomes following combined immunotherapy and chemotherapy. The elevated risk of CIP was significantly associated with non-fibrotic subpleural patterns and ground-glass opacities. Systematic pre-treatment ILA screening and risk stratification are recommended to guide individualized treatment decisions in advanced NSCLC.

     

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