Analysis Of Risk Factors Of Immune-related Pneumonitis In Advanced Lung Cancer And Its Correlation With The Efficacy Of Immunotherapy

Objective: To explore the risk factors of checkpoint inhibitors pneumonitis(CIP)in patients with advanced lung cancer treated with immune checkpoint inhibitors and its correlation with the efficacy of immunotherapy.Methods: Clinical data of patients with locally advanced or advanced lung cancer who were first treated with immune checkpoint inhibitor monotherapy or combined with other antineoplastic drugs in Liaoning Cancer Hospital from January 1,2019 to July 31,2022 were collected retrospectively.It includes basic clinical features,peripheral blood indexes before the first immunotherapy and during the occurrence of pneumonia,treatment outcome and survival data,etc.Analysis of risk factors affecting the occurrence of CIP by logistic regression.KaplanMeier method was used to draw survival curve,and Long-rank test was used to compare the survival difference between CIP group and non-CIP group.Cox proportional hazard regression was used to analyze the related factors affecting the prognosis of CIP patients treated with immunotherapy.Results:1.Of the 142 patients included in the study,22 developed CIP(15.5%),with a median time of 78 days for CIP.Male(OR=4.815,95%CI:1.071-21.641,P=0.040),smoking history(OR=3.000,95%CI:1.140-7.896,P=0.026),basic lung disease history(OR=6.444,95%CI:1.479-28.089,P=0.013),chest radiotherapy history(OR=4.125,95%CI:1.319-12.897,P=0.015)and ICI monotherapy(OR=5.143,95%CI:1.793-14.751,P=0.002)are associated with an increased risk of CIP.Squamous cell carcinoma is associated with a higher incidence than adenocarcinoma.The history of basic lung diseases(OR=8.818,95%CI:1.629-47.734,P=0.012)and ICI monotherapy(OR=4.792,95%CI:1.411-16.270,P=0.012)are independently related to the occurrence of CIP.2.The median PFS of patients with CIP was 12.8 months(95%CI:8.879-16.654),and that of patients without CIP was 8.6 months(95%CI:6.129-11.071).The difference was not statistically significant(P=0.395).Cox univariate analysis showed that patients with CIP in stage III had shorter PFS than patients with stage IV CIP(HR=4.376,95%CI:1.250-15.323).3.Most of the CIP patients were relieved after hormone treatment,11 CIP patients received ICI challenge therapy,and 6 patients had CIP recurrence(54.5%).Grade ≥ 3 was found in 3 cases(27.3%).The incidence and severity were higher than those of the first time..Conclusion: The history of basic lung diseases and ICI monotherapy are independent risk factors for CIP.The occurrence of CIP does not affect the survival of patients with advanced lung cancer.The recurrence rate and severity of CIP in patients with CIP after immune rechallenge therapy are higher than before,which still need to be carefully selected.