Correlation Analysis Of Predictive Factors Of Adverse Reactions Related To Immunotherapy For Lung Cancer

Background and objective:With the increasing use of immune checkpoint inhibitors(ICIs)in oncology treatment regimens,more and more oncology patients are receiving and benefiting from ICIs.However,it should not be overlooked that ICIs may be followed by a series of adverse events(irAEs)involving all organs and tissues throughout the body.Although the severity of irAEs remains uncommon,there are still some situations that exist that may result in serious or even life-threatening adverse outcomes.Therefore,there is an urgent need for clinicians to increase their understanding of the characteristics and management of irAEs and to identify indicators that can predict the occurrence of irAEs early enough to make the right decisions.In this study,we analyzed the clinical data of advanced lung cancer patients with/without irAEs before treatment with ICIs to explore the risk factors that may lead to the occurrence of irAEs after treatment with ICIs,expecting that the early detection of irAEs will lead to better detection and identification of the problem.Methods:A retrospective review of the electronic files of the Department of Respiratory and Critical Care Medicine,Department of Thoracic Surgery and Department of Oncology and Hematology of the Second Norman Bethune Hospital of Jilin University from 01,2022 to 07,2022 selected the clinical data of 142 eligible patients with advanced lung malignancies treated with immune checkpoint inhibitors,and the basic information of the study subjects including: gender,age,family history of lung cancer,body mass index(BMI).The basic data including gender,age,family history of lung cancer,BMI,smoking habit,pathological type,TNM staging,treatment plan,peripheral blood immune cells,biochemical indexes and tumor markers were statistically analyzed.A logistic regression model was applied to determine the correlation between irAEs and baseline data characteristics,venous blood immune cells and biochemical indexes of the study subjects.The ROC curves were analyzed and the Jorden index was calculated to determine the critical values of the parameters.Results:1.The proportion of male patients in the irAEs group was higher than that in the non-ir AE group,and after statistical analysis,the difference was found to be significant(P < 0.05);after comparing the age,BMI,family history of lung cancer,smoking history and smoking index,ECOG score,pathological type,TNM stage,distant metastasis,treatment plan and past history of cerebral infarction,diabetes mellitus and hypertension in the two groups,it was found that the differences were not significant(P > 0.05).In these studies,the proportion of men was significantly higher than that of women,and most of them were middle-aged and elderly.2.Fifty-three patients presenting with irAEs had small cell carcinoma in 41.5%,squamous carcinoma in 28.3%,adenocarcinoma in 24.5%,and other in 5.7%.It was found that the incidence of squamous cell carcinoma was significantly higher in men than in women,and this difference was statistically significant(P<0.001).The difference in the incidence of small cell carcinoma,adenocarcinoma and other types of lung malignancies by gender was not statistically significant(P > 0.05).46.9% of male lung cancer patients had squamous carcinoma as the pathological type and52.4% of female lung cancer patients had small cell carcinoma as the pathological type.3.Overall,this retrospective cohort study observed that the incidence and general characteristics of irAEs in patients with advanced lung cancer were positively correlated with the findings of previous studies on the treatment of ICIs.The overall incidence of irAEs was 37.3%(53/142 cases),of which 47 were ‘single’ irAEs and 6were ‘multipl’ irAEs;the incidence of high-grade irAEs was 4.2%(6/142 cases).The median time to first irAEs was 9 weeks.All patients were treated according to the guidelines for the management of irAEs.4.The patients in the irAEs group had a higher absolute eosinophil count(AEC)than the non-ir AE group,and the difference was statistically significant(P < 0.05);the results showed that the albumin value(ALB)level was significantly higher compared to the non-ir AE group(P < 0.05),and this difference was statistically significant;after blood creatinine(Scr)measurement,the Scr level was significantly higher compared to the non-ir AE group(P < 0.05),and this result was statistically significant.The differences in biochemical indices such as hemoglobin,platelet count,alanine aminotransferase,portal aminotransferase,lactate dehydrogenase,C-reactive protein,urea nitrogen,uric acid,glomerular filtration rate,D-dimer,fibrinogen,brain natriuretic peptide,NLR,PLR and MLR between the two groups were not significant(P > 0.05).5.The level of squamous epithelial cell carcinoma antigen was lower in the irAEs group than in the non-ir AE group,and the difference was statistically significant(P < 0.05);Higher levels of glycoantigen 724 than in the non-ir AE group and the difference was significant(P < 0.05).The differences in the remaining tumor markers such as cytokeratin 19 fragment,abnormal prothrombin,neuron-specific enolase,β2 microglobulin,total prostate-specific antigen,human chorionic gonadotropin,premenopausal ROMA value,postmenopausal ROMA value and hepatitis B-associated liver cancer risk assessment were not statistically significant between the two groups(P > 0.05).6.This study explored the predictors of irAEs and showed that male(P<0.05),higher ALB(threshold=39.05g/L,P=0.042)and higher Scr(threshold=86umol /L,P=0.048)were significantly associated with the occurrence of irAEs.Conclusion:1.The incidence of irAEs was higher in men among immunotherapy patients with lung cancer,especially in squamous carcinoma,which was more significant.2.Patients with irAEs had higher absolute eosinophil counts,albumin values and blood creatinine levels;Higher levels of glycoantigen 724 and lower levels of squamous epithelial cell carcinoma antigen.3,Multi-factor logistic regression analysis showed that male,higher albumin value(ALB>39.05g/L)and higher blood creatinine level(Scr>86umol/L)were independent risk factors for the occurrence of irAEs.