晚期非小细胞肺癌患者免疫治疗不良反应风险因素分析

陈秀梅; 陈思涓; 甘彬; 丘婕; 崔虹; 严红虹

doi:10.12019/j.issn.1671-5144.2023.03.006

晚期非小细胞肺癌患者免疫治疗不良反应风险因素分析

Analysis of the Status and Influencing Factors of Immune-Related Adverse Events in Advanced Non-Small-Cell Lung Cancer Patients

摘要

摘要:
目的了解晚期非小细胞肺癌患者接受程序性死亡受体1（programmed cell death 1，PD-1）抑制剂治疗相关不良反应的发生率和影响因素。
方法采用一般资料调查问卷对广东省人民医院的261例晚期非小细胞肺癌患者进行横断面调查，利用不良反应事件评价标准（Common Terminology Criteria for Adverse Events，CTCAE）5.0版进行判别，同时分析患者发生免疫相关不良反应的影响因素。
结果 261例患者中有139例（53.3%）出现相关不良反应，常见为乏力、恶心、皮疹、瘙痒症、肺炎。Logistic回归分析结果显示：吸烟史比值比（odds ratio，OR）=2.75，95%可信区间（confidence interval，CI）1.59~4.75，P < 0.001、免疫抑制剂治疗为2个周期（OR=6.84，95%CI 2.47~18.95，P < 0.001），3个周期及以上（OR=4.51，95%CI 1.71~11.89，P=0.002）、PD-1抑制剂合并靶向治疗（OR=34.11，95%CI 4.21~276.18，P=0.001）是晚期非小细胞肺癌患者发生免疫治疗相关不良反应的危险因素。
结论晚期非小细胞肺癌患者接受免疫抑制剂治疗时不良反应的发生率较高，医护人员应加强对有吸烟史、免疫抑制剂的治疗周期为2个周期且合并其他治疗患者的关注，提供有针对性的观察和预防处理，以减少不良反应的发生。

Abstract:
Objective To investigate the incidence and influencing factors of immune-related adverse events in advanced non-small-cell lung cancer patients receiving programmed cell death 1(PD-1)immune checkpoint inhibitors therapy.
Methods A cross-sectional survey was conducted on 261 advanced non-small-cell lung cancer patients in Guangdong Provincial People's Hospital by the general data questionnaire using the Common Terminology Criteria for Adverse Events(CTCAE), and the influencing factors of immune-related adverse events were analyzed.
Results 139 cases(53.3%)of 261 had related adverse events, among which fatigue, nausea, rash, pruritus, and pneumonia were common. Logistic regression analysis results showed that smoking status odds ratio (OR)=2.75, 95% confidence interval(CI)1.59~4.75, P < 0.001, 2 cycles of immune checkpoint inhibitors therapy(OR=6.84, 95%CI 2.47~18.95, P < 0.001), 3 cycles and above of immune checkpoint inhibitors therapy(OR=4.51, 95%CI 1.71~11.89, P=0.002), and the PD-1 immune checkpoint inhibitors therapy combined with targeted therapy(OR=34.11, 95%CI 4.21~276.18, P= 0.001)were the risk factors of immune-related adverse events.
Conclusions Patients with advanced non-small cell lung cancer have a higher incidence of immune-related adverse events during treatment with immune checkpoint inhibitors. Medical staff should pay more attention to patients with a history of smoking, a 2-cycle immune checkpoint inhibitors treatment combined with other treatments, and provide targeted observation and preventive treatment to reduce the occurrence of immune-related adverse events.

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