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Association of pre-existing lung interstitial changes with immune-related pneumonitis in patients with non-small lung cancer receiving immunotherapy

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Abstract

Background and aim

Many pieces of literature have evaluated the predictive value of pre-existing lung interstitial changes for immunotherapy-related pneumonia in patients with non-small cell lung cancer (NSCLC), but the results of studies are still controversial. The purpose of this article is to explore whether pre-existing lung interstitial changes can predict the occurrence of immunotherapy-related pneumonia.

Methods

PubMed, Web of Science, and Embase were used to search for relevant documents. Two investigators respectively carried out literature screening, quality evaluation, and data extraction strictly according to the inclusion criteria. Odds ratios (ORs) and the corresponding 95% CIs were applied to assess the predictive value of interstitial lung disease (ILD), interstitial lung abnormalities (ILA), and radiation pneumonitis (RP). Stata 12.0 software was used for the statistical analysis of data.

Results

Seventeen studies involving 2758 patients were included in the final analysis. NSCLC patients with pulmonary interstitial changes were more likely to develop immune-related pneumonia after immunotherapy (OR = 3.68, 95% CI: 2.49–5.44). Subgroup analysis revealed that ILD (OR = 3.59, 95% CI: 2.22–5.82), RP (OR = 3.63, 95% CI: 1.80–7.30), and ILA (OR = 6.64, 95% CI: 1.78–24.8) were all predictors of immune-related pneumonia. As the preliminary screening of other risk factors, gender, neutrophilic lymphocyte ratio (NLR), actual eosinophil count (AEC), and drug type may have potential predictive value for immunotherapy-related pneumonia. There was no significant statistical heterogeneity and publication bias in our study. Further research is needed to update and validate our results.

Conclusion

Pulmonary interstitial changes can be considered as a predictive factor of immune-related pneumonia after immunotherapy in NSCLC patients.

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Funding

This present research was funded by the National Natural Science Foundation of China (to Richeng Jiang) (No. 81372517) and the Nature Science Foundation of Tianjin City (to Richeng Jiang) (No. 18JCZDJC 98800).

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Authors and Affiliations

  1. Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China

    Xiuqiong Chen, Zhaona Li, Xinyue Wang, Jing Zhou, Qianhui Wei & Richeng Jiang

  2. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China

    Xiuqiong Chen, Zhaona Li, Xinyue Wang, Jing Zhou, Qianhui Wei & Richeng Jiang

  3. Tianjin’s Clinical Research Center for Cancer, Tianjin, China

    Xiuqiong Chen, Zhaona Li, Xinyue Wang, Jing Zhou, Qianhui Wei & Richeng Jiang

  4. Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China

    Xiuqiong Chen, Zhaona Li, Xinyue Wang, Jing Zhou, Qianhui Wei & Richeng Jiang

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  1. Xiuqiong Chen
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  2. Zhaona Li
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  3. Xinyue Wang
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  4. Jing Zhou
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Contributions

X. Q. and R. C. designed and performed the study, and wrote the manuscript. Z. N. and X. Y. extracted the information and assisted in information collection and analysis. Z. J. and Q. H. revised the manuscript critically and confirmed correct data analysis.

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Correspondence to Richeng Jiang.

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Fig. S1

Sensitivity analysis plot for 14 studues considering ILD and ICI-pneumonia. (PNG 526 kb)

High Resolution (TIF 2623 kb)

Fig. S2

Forest plot of odds ratios for the association between other risk factors and ICI-pneumonia. (A). association between age and ICI-pneumonia. (B). association between gender and ICI-pneumonia. (C). association between ECOG and ICI-pneumonia. (D). association between smoking and ICI-pneumonia. (E). association between pathology and ICI-pneumonia. (F). association between treatment line and ICI-pneumonia. (G). association between chest radiation and ICI-pneumonia. (H). association between drug type and ICI-pneumonia. (I). association between CRP and ICI-pneumonia. (J). association between WBC and ICI-pneumonia. (K). association between NLR and ICI-pneumonia. (L). association between AEC and ICI-pneumonia. (M). association between LDH and ICI-pneumonia. (N). association between ALB and ICI-pneumonia. (PNG 1939 kb)

High Resolution (TIF 6483 kb)

Fig. S3

Forest plot of odds ratios for subgroup analysis of the association between lung interstitial changes and ICI-pneumonia according to study type. (PNG 48 kb)

High Resolution (TIF 2044 kb)

Supplementary file4 (DOCX 15 KB)

Supplementary file5 All abbreviations and full names in the manuscript. (DOCX 14 KB)

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Chen, X., Li, Z., Wang, X. et al. Association of pre-existing lung interstitial changes with immune-related pneumonitis in patients with non-small lung cancer receiving immunotherapy. Support Care Cancer 30, 6515–6524 (2022). https://doi.org/10.1007/s00520-022-07005-6

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