程序性细胞死亡1受体抑制剂治疗老年非小细胞肺癌导致皮肤免疫相关不良事件研究

doi:10.3969/j.issn.1003-9198.2025.04.009

摘要/Abstract

摘要： 目的探讨老年非小细胞肺癌(NSCLC)病人接受程序性细胞死亡1受体(PD-1)抑制剂治疗后皮肤免疫相关不良反应(s-irAE)的发生情况及其与生存预后和临床指标之间的相关性。方法收集2020年3月至2023年3月在内蒙古医科大学附属医院接受PD-1抑制剂单药一线治疗的老年NSCLC病人的临床资料。根据病人是否发生s-irAE,将其分为s-irAE组和无s-irAE组,比较2组无进展生存时间(PFS)、总生存时间(OS)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)和预后营养指数(PNI)的差异。结果共40例病人纳入分析, s-irAE的发生率为52.5%(21/40),其中≥3级s-irAE的发生率为5.0%(2/40),s-irAE的中位发生治疗周期为4.0(3.0,5.0)个,s-irAE发生的主要类型为皮疹伴瘙痒和毛细血管增生症。与无s-irAE组比较,s-irAE组的中位PFS、OS更长(未达到比9.0个月,HR=0.211,95%CI:0.073～0.606;未达到比12.0个月,HR=0.233,95%CI:0.073～0.748)。s-irAE组和无s-irAE组间PNI、NLR和PLR差异均无统计学意义(P＞0.05)。结论在接受PD-1抑制剂单药一线治疗的老年NSCLC病人中,s-irAE的发生率较高,需要警惕。但是s-irAE的发生预示着更好的生存预后,而s-irAE预测指标尚需进一步研究。

关键词: 非小细胞肺癌, 程序性细胞死亡1受体抑制剂, 皮肤免疫相关不良反应

Abstract: Objective To investigate the incidence of skin-immune-related adverse events(s-irAE) in the elderly patients with non-small cell lung cancer(NSCLC) undergoing treatment with programmed cell death 1 receptor(PD-1) inhibitors, and to investigate the correlation of s-irAE with survival prognosis and clinical indictors. Methods The clinical data of the elderly patients with NSCLC were collected from the Affiliated Hospital of Inner Mongolia Medical University from March 2020 to March 2023. These patients received first-line treatment with PD-1 inhibitor monotherapy. The patients were divided into s-irAE group and non-s-irAE group according to whether they presented with s-irAE. The levels of progression-free survival(PFS), overall survival(OS), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR) and prognostic nutritional index(PNI) were compared between the two groups. Results A total of 40 patients were enrolled. The incidence rate of s-irAE was 52.5%(21/40), and the incidence rate of grade ≥3 s-irAE was 5.0%(2/40). The median occurrence treatment cycle of s-irAE was 4.0 (3.0, 5.0), and the main types of s-irAE were rash with pruritus and capillary hyperplasia. Compared with the non-s-irAE group, the s-irAE group had longer median PFS, OS (not reach vs 9.0 months, HR=0.211, 95% CI: 0.073-0.606, P=0.004), (not reach vs 12.0 months, HR=0.233, 95% CI: 0.073-0.748, P=0.014). The levels of PNI, NLR and PLR showed no significant differences between s-irAE group and non-s-irAE group(all P＞0.05). Conclusions The incidence rate of s-irAE is high in the elderly NSCLC patients receiving first-line treatment with PD-1 inhibitor monotherapy. However, the occurrence of s-irAE predicts a better survival prognosis, and predictors for the s-irAE need further study.

Key words: non-small cell lung cancer, programmed cell death 1 receptor inhibitor, skin-immune-related adverse events

中图分类号:

R 734.2

王少军, 曹冉华, 苏乌云, 刘彩霞. 程序性细胞死亡1受体抑制剂治疗老年非小细胞肺癌导致皮肤免疫相关不良事件研究[J]. 实用老年医学, 2025, 39(4): 367-371.

WANG Shaojun, CAO Ranhua, SU Wuyun, LIU Caixia. Study on skin-immune-related adverse events due to programmed cell death 1 receptor inhibitors therapy in elderly patients with non-small cell lung cancer[J]. Practical Geriatrics, 2025, 39(4): 367-371.

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