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不同器官的免疫检查点抑制剂相关炎症变化的频率和后果:一项超过13年的解剖研究

Umberto Maccio¹, Andreas Wicki², Frank Ruschitzka³

¹Department of Pathology and Molecular Pathology, University Hospital of Zurich, Zurich, Switzerland.

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

|December 15, 2024

概括

免疫检查点抑制剂 (ICI) 可以引起与免疫相关的不良事件 (irAEs). 尸体解剖研究显示,心肌炎和肌底炎等irrAEs的诊断不足显著,一些死亡直接与ICI治疗有关.

科学领域:

在瘤学瘤学.
免疫学免疫学免疫学
病理学病理学病理学

背景情况:

免疫检查点抑制剂 (ICI) 已经改变了癌症治疗,但可以引起与免疫相关的不良事件 (irAEs).
之前的研究缺乏全面的尸检数据,以充分了解irAEs的系统效应和病理学.

研究的目的:

通过全身解剖来确定ICI相关炎症变化的频率,器官分布,形态和临床相关性.
评估与尸检发现相比,临床上怀疑的irrAEs的诊断准确性.

主要方法:

在2011年1月至2024年3月期间,从2011年1月至2024年3月期间接受ICI治疗的患者进行了42次全身解剖的回顾性分析.
评价器官分布,炎症变化的形态和与临床数据的相关性.

主要成果:

超过一半的患者 (54.8%) 在至少一个器官中表现出irrAEs.
最常见的irrAEs包括低血清炎 (28.6%),心肌炎 (19.0%),肝炎 (14.3%),肺炎 (11.9%),上腺炎 (11.9%).
与ICI相关的心肌炎是最常见的死亡原因 (71.4%的ICI相关死亡),通常在临床上没有怀疑 (62.5%). 脑炎只有在尸检时才被发现.
死于irAEs的患者显示了较高的完全瘤回归率 (P = .018).
肌心炎和肺炎与全身性irrAEs有关.

结论:

尸体解剖研究对于理解ICI相关毒性的全谱至关重要.
观察到对irAEs的显著低诊断,特别是心肌炎,低炎和脑炎.
尸检仍然是监测ICI诊断准确性和治疗副作用的宝贵工具.

关键词:

尸体解剖尸体解剖是什么意思低血压症是什么意思?免疫检查点抑制剂免疫检查点抑制剂与免疫相关的不良事件.肌性心肌炎是一种心肌炎.肺炎是一种肺炎.

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