摘要
目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗的疗效和免疫检查点抑制剂相关肺炎(checkpoint inhibitor pneumonitis,CIP)发生率的影响。方法采用回顾性队列研究设计方案,纳入2019年1月至2021年8月在陆军军医大学第二附属医院接受至少2次ICIs治疗的Ⅲb-Ⅳ期NSCLC患者379例,根据慢性阻塞性肺疾病全球倡议(global initiative for chronic obstructive lung disease,GOLD)2021或胸部高分辨CT诊断是否合并COPD,其中184例为NSCLC合并COPD组(NSCLC-COPD组),195例为单纯NSCLC组(NSCLC组),收集疗效终点指标包括客观缓解率(objective response rate,ORR)、无进展生存期(progression free survival,PFS)、总生存期(overall survival,OS)和CIP的发生率,分析COPD对晚期NSCLC患者接受ICIs治疗疗效和CIP发生率的影响。结果NSCLC-COPD组接受ICIs治疗的ORR显著优于NSCLC组(45.7%vs 35.4%,P=0.042)。调整混杂因素后的多因素Logistic分析显示,合并COPD是ORR的独立预后因素(HR=0.587,95%CI:0.379~0.909;P=0.017)。与NSCLC组相比,NSCLC-COPD组患者中位PFS更长(14.6月vs 10.9月;P=0.023)。调整混杂因素后的多因素Cox分析显示,合并COPD可能是PFS的良性预后因素(HR=0.768;95%CI:0.581~1.015;P=0.064)。COPD与OS无明显相关性。所有患者中13例患者发生CIP,其中NSCLC-COPD组9例(4.9%),NSCLC组4例(2.1%),两组发生率无统计学差异(P=0.162)。结论NSCLC合并COPD的患者接受ICIs治疗的ORR、PFS显著优于单纯NSCLC患者,提示COPD是晚期NSCLC患者接受ICIs治疗获得较好疗效的潜在预测因素。合并COPD并未增加CIP的发生风险。
Objective To investigate the effects of chronic obstructive pulmonary disease(COPD)on the clinical efficacy and incidence of checkpoint inhibitor pneumonitis(CIP)in patients with advanced non-small cell lung cancer(NSCLC)receiving immune checkpoint inhibitors(ICIs).Methods A retrospective cohort study was performed in 379 patients withⅢb-ⅣNSCLC who received at least 2 times of ICIs treatment in the Second Affiliated Hospital of Army Medical University from January 2019 to August 2021.According to the Global Initiative for Chronic Obstructive Lung Disease(GOLD)2021 and diagnostic criteria of COPD by chest high-resolution CT scans,184 patients were assigned into NSCLC combined with COPD group(NSCLC-COPD group)and 195 into the simple NSCLC group(NSCLC group).The efficacy indicators of end points included objective response rate(ORR),progression free survival(PFS),overall survival(OS)and incidence of CIP.The effects of COPD on the efficacy of ICIs and incidence of CIP were analyzed in these NSCLC patients.Results The ORR was significantly better in the NSCLC-COPD group than the NSCLC group(45.7%vs 35.4%,P=0.042).Multivariate logistic regression analysis after adjustment for confounding factors showed that complication of COPD was an independent prognostic factor of ORR(HR=0.587,95%CI:0.379~0.909,P=0.017).The median PFS of the NSCLC-COPD group was obviously longer than that of the NSCLC group(14.6 vs 10.9 months,P=0.023).Multivariate Cox analysis indicated that COPD might be a factor for good prognosis of PFS(HR=0.768,95%CI:0.581~1.015,P=0.064).No significant correlation was observed between COPD and OS.Among the 13 patients with CIP in all these patients,9 patients(4.9%)were in the NSCLC-COPD group and 4 patients(2.1%)in NSCLC group.There was no statistical difference between the 2 groups(P=0.162).Conclusion ICIs result in better ORR and PFS in NSCLC-COPD patients than those only NSCLC,suggesting that COPD is a potential predictor of better response to ICIs.The presence of COPD does not increase the risk of CIP.
作者
毕周奎
单亦凡
张文静
游雅婷
赵才林
陈旻旻
夏婷婷
李亚斐
白莉
BI Zhoukui;SHAN Yifan;ZHANG Wenjing;YOU Yating;ZHAO Caiin;CHEN Minmin;XIA Tingting;LI Yafei;BAI Li(Department of Respiratory and Critica Care Medicine Second Affiiated Hospita Army Medica University(Third Military Medial University),Chongqing,400037;Department of Epidemiology,Faculty of Military Preventive Medicine,Army Medical University(Third Military Medial University),Chongqing,400037,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2023年第11期1189-1196,共8页
Journal of Army Medical University
基金
重庆市科卫联合医学科研项目(2022ZDXM023)。
关键词
非小细胞肺癌
慢性阻塞性肺疾病
免疫检查点抑制剂
non-small cell lung cancer
chronic obstructive pulmonary disease
immune checkpoint inhibitors
