基线胸部成像异常是免疫检查点抑制剂相关肺炎的风险因素
Danielle Stahlbaum1, Renea Jablonski2, Mary E Strek2
1Section of Pulmonary and Critical Care, Department of Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
Respiratory medicine
|June 29, 2023
概括
患有异常基线胸部CT扫描和GERD的患者面临更高的免疫检查点抑制性肺炎 (ICI-肺炎) 的风险. 在治疗前进行评估至关重要,因为许多患者患有未被诊断的慢性肺病.
科学领域:
- 在瘤学瘤学.
- 肺部病理学 肺部病理学
- 放射学 放射学是一门学科.
背景情况:
- 慢性肺病是免疫检查点抑制性肺炎 (ICI-肺炎) 的疑似危险因素.
- 关于先前存在的肺部疾病和基线成像如何影响ICI肺炎风险的数据有限.
研究的目的:
- 调查先前存在的肺部疾病,基线胸部成像异常和发展ICI-肺炎的风险之间的关联.
- 在接受免疫检查点抑制剂治疗的患者中识别ICI肺炎的风险因素.
主要方法:
- 对2015-2019年期间接受ICI治疗的癌症患者进行了回顾性队列研究.
- ICI肺炎的诊断经由治疗医生和独立审查证实,不包括其他原因.
- 统计分析包括费舍尔的精确测试,学生的t测试和后勤回归.
主要成果:
- 异常的基线胸部CT发现 (肺瘤,支气管切除,不透明) 显著增加了ICI-肺炎风险 (OR 3.41).
- 胃食道逆流病 (GERD) 也增加了ICI肺炎的风险 (OR 3.83).
- 多变量分析证实异常成像和/或GERD是ICI肺炎的独立风险因素.
结论:
- 基线胸部CT异常和GERD是发展ICI肺炎的重要危险因素.
- 很大一部分患者 (18%) 在没有正式诊断的情况下有慢性肺病的放射性证据.
- 建议在ICI开始前进行多学科评估,以评估与未诊断的肺部疾病相关的风险.
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