Relationship between pneumonitis induced by immune checkpoint inhibitors and the underlying parenchymal status: a retrospective study
Relationship between pneumonitis induced by immune checkpoint inhibitors and the underlying parenchymal status: a retrospective study
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DOI：
10.1183/23120541.00165-2019
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发表时间：
2020-01-01
影响因子：
4.6
通讯作者：
Beigelman-Aubry, Catherine
中科院分区：
文献类型：
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作者：
Pozzessere, Chiara;Bouchaab, Hasna;Beigelman-Aubry, Catherine
在接受免疫检查点抑制剂治疗的原发性或继发性肺肿瘤患者中，免疫相关性肺炎是一种罕见的不良事件，但可能演变成呼吸衰竭。需要及时处理，通常包括中断治疗和施用免疫抑制药物。本研究的目的是评估免疫相关性肺炎与先前存在的实质状态之间的关系，特别是肿瘤位置和胸部放疗史之间的关系。回顾性分析了免疫相关性肺炎患者的计算机断层扫描（CT）扫描。对六个肺部区域的肺炎模式、分布和范围进行了评估。在接受放射治疗的患者中，根据放射野评估肺炎的程度。在253例接受免疫治疗的患者中，发现15例免疫相关性肺炎。除免疫治疗外，10 名患者之前或同时接受过胸部放疗。在 CT 扫描中，88 个区域中的 29 个 (33%) 包含原发肿瘤 (n=4)、肺转移瘤 (n=4) 和/或放射野 (n=21)。与其他区域（3%，p=0.009）相比，原发性或转移性恶性肿瘤和/或放射野区域（97%）内发生免疫相关性肺炎实质受累的患病率显着更高。受原发肿瘤、转移或放射治疗影响的肺部区域比其他区域发生免疫相关肺炎的可能性更高（OR 10.8，p=0.024）。放疗后机化性肺炎 (OP) 模式更常见（70% 与 0%，p=0.024），而非特异性间质性肺炎特征在未接受放疗的患者中更常见（100% 与 10%，p=0.002）。在接受免疫检查点抑制剂治疗的原发性或继发性肺肿瘤患者中，免疫相关性肺炎优先位于肿瘤和/或放射野涉及的肺部区域。
In patients with primary or secondary lung tumour treated with immune checkpoint inhibitors, immune-related pneumonitis is a rare adverse event but may evolve to respiratory failure. Prompt management is required and usually consists of treatment interruption and immunosuppressive drug administration. The aim of this study was to evaluate relationships between immune-related pneumonitis and pre-existing parenchymal status, especially tumour location and history of chest radiotherapy.Computed tomography (CT) scans of patients with immune-related pneumonitis were retrospectively reviewed. Pattern, distribution and extent of pneumonitis were assessed in six lung regions. In patients who received radiotherapy, the extent of pneumonitis was evaluated according to the radiation field.Among 253 patients treated with immunotherapy, 15 cases of immune-related pneumonitis were identified. 10 had previous or concomitant chest radiotherapy in addition to immunotherapy. At CT scan, 29 (33%) out of 88 regions encompassed the primary tumour (n=4), a lung metastasis (n=4) and/or radiation fields (n=21). A significantly higher prevalence of parenchymal involvement by immune-related pneumonitis occurred within areas of primary or metastatic malignancy and/or radiation field (97%) as compared to other areas (3%, p=0.009). Lung regions affected by the primary tumour, metastasis or radiotherapy had a higher probability of immune-related pneumonitis than others (OR 10.8, p=0.024). An organising pneumonia (OP) pattern was more frequent after radiotherapy (70% versus 0%, p=0.024), whereas nonspecific interstitial pneumonia features were more commonly seen in radiotherapy-naive patients (100% versus 10%, p=0.002).In patients with primary or secondary lung tumour treated with immune checkpoint inhibitors, immunerelated pneumonitis is preferentially located within lung areas involved by tumour and/or radiation fields.