在诊断出免疫检查点抑制剂介导的大肠炎后,结肠腺瘤
Antonio Pizuorno Machado1, Malek Shatila2, Enrico N De Toni3
1Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA.
用免疫检查点抑制剂 (ICI) 治疗的大肠炎的患者在一年内出现新的结肠,包括腺瘤的发病率显著增加. 这一发现凸显了ICI相关结肠炎后长期结肠健康监测的必要性.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 可以引起结肠炎,这是一个已知的免疫激活指标,与有利的癌症结果相关.
- ICI诱导的大肠炎对结肠壁膜的长期影响仍未得到充分研究.
- 了解这些长期变化对于患者管理和癌症治疗策略至关重要.
研究的目的:
- 在经历免疫检查点抑制剂 (ICI) 中介性结肠炎后至少6个月的患者中调查结肠镜和组织学发现.
- 为了比较患有ICI大肠炎史和没有ICI大肠炎史的患者的结肠的发病率.
主要方法:
- 对2013年至2020年期间被诊断患有ICI大肠炎的成人癌症患者的回顾性分析.
- 包括随访结肠镜检查的患者和暴露于ICI而没有结肠炎的对照组.
- 在诊断和随访 (≥6个月) 时评估临床过程,治疗,内镜和组织学特征.
主要成果:
- 51.2%的ICI大肠炎患者出现了新的结肠,包括33.3%的腺瘤,平均12个月的随访时间.
- 与对照组相比,ICI结肠炎组中腺瘤多的发生率明显高于ICI结肠炎组 (p=0.041).
- 初始结肠炎通常呈现为无的炎症 (76.9%内镜),并用皮质类固醇 (79.4%) 治疗.
结论:
- 患有ICI诱导性结肠炎病史的患者在一年内显著增加了新的结肠,包括腺瘤的发病率.
- 这些发现表明,ICI结肠炎可能对结肠健康产生长期影响,需要进一步调查.
- 需要进行更大规模的研究,以完善这种患者群体中结肠腺瘤和结肠直肠癌的监测建议.
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