Pneumonitis

肺炎
  • 文章类型: Journal Article
    免疫检查点抑制剂(ICI)疗法通过增强针对肿瘤细胞的免疫反应,彻底改变了癌症治疗。然而,它们对免疫途径的影响可导致免疫相关的不良事件,如肺炎,需要快速诊断和管理以防止严重并发症。这些不良事件是由免疫治疗药物激活免疫系统引起的,导致免疫介导的炎症和组织损伤在整个身体的各种器官和组织。本综述文章讨论了病理生理学,临床表现,ICI相关肺炎的诊断方式和管理策略,强调早期识别和量身定制的干预措施。未来的研究工作应该集中在阐明肺炎的潜在机制和识别预测性生物标志物,以指导在这个不断发展的肿瘤学领域的个性化治疗策略。
    Immune checkpoint inhibitor (ICI) therapy has revolutionized cancer treatment by enhancing the immune response against tumor cells. However, their influence on immune pathways can lead to immune-related adverse events such as pneumonitis, necessitating rapid diagnosis and management to prevent severe complications. These adverse events arise from the activation of the immune system by immunotherapeutic drugs, leading to immune-mediated inflammation and tissue damage in various organs and tissues throughout the body. The present review article discusses the pathophysiology, clinical presentation, diagnostic modalities and management strategies for ICI-related pneumonitis, emphasizing early recognition and tailored interventions. Future research endeavors should focus on elucidating the underlying mechanisms of pneumonitis and identifying predictive biomarkers to guide personalized treatment strategies in this evolving field of oncology.
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  • 文章类型: Journal Article
    用电离辐射治疗胸部肿瘤可引起放射性肺损伤(RILI),其中包括放射性肺炎和放射性肺纤维化。预防RILI对于控制肿瘤生长和改善生活质量至关重要。然而,传统RILI治疗方法的严重不良反应仍然是主要障碍,需要开发既安全又有效的新型治疗方案。这篇综述总结了RILI的分子机制,并探讨了新的治疗方案。包括天然化合物,基因治疗,纳米材料,和间充质干细胞。这些最近的实验方法显示了在临床实践中作为RILI的有效预防和治疗选择的潜力。
    The treatment of thoracic tumors with ionizing radiation can cause radiation-induced lung injury (RILI), which includes radiation pneumonitis and radiation-induced pulmonary fibrosis. Preventing RILI is crucial for controlling tumor growth and improving quality of life. However, the serious adverse effects of traditional RILI treatment methods remain a major obstacle, necessitating the development of novel treatment options that are both safe and effective. This review summarizes the molecular mechanisms of RILI and explores novel treatment options, including natural compounds, gene therapy, nanomaterials, and mesenchymal stem cells. These recent experimental approaches show potential as effective prevention and treatment options for RILI in clinical practice.
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  • 文章类型: Journal Article
    由表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI)或免疫检查点抑制剂(ICI)引起的间质性肺病(ILD)或肺炎是非小细胞肺癌(NSCLC)治疗中的主要问题。添加血管内皮生长因子(VEGF)和VEGF受体(VEGFR)抑制剂是否可以降低药物诱导的ILD的发生率尚不清楚。我们在2009年1月至2023年10月的相关随机试验中进行了系统评价,以评估存在或不存在VEGF/VEGFR抑制剂时EGFR-TKIs或ICIs诱导的ILD的发生率。主要结果是全球所有患者和亚洲人ILD发生率的比值比。次要结果是全球所有患者和亚洲人的3级或更高ILD发生率的比值比(OR)。我们确定了13项随机研究,EGFR-TKI组中的一个子分析,ICI组的三项随机研究。在EGFR-TKI组中,使用VEGF/VEGFR抑制剂的任何级别的ILD发生率的OR为0.54(95%CI,0.32-0.90;p=0.02),这表明发病率显著低于无VEGF/VEGFR抑制剂。相反,使用VEGF/VEGFR抑制剂的≥3级ILD发生率的OR为1.00(95%CI,0.43-2.36;p=0.99).在ICI组的所有受试者中,使用VEGF/VEGFR抑制剂的任何级别ILD发生率的OR为0.78(95%CI,0.51-1.21;p=0.27).系统评价表明,在NSCLC患者中,添加VEGF/VEGFR抑制剂可以降低EGFR-TKI引起的任何级别的药物诱导ILD的发生率,但在≥3级时不能降低。由于可获得ILD数据的随机试验数量有限,ICIs诱导的ILD仍未确定。
    https://www.crd.约克。AC.uk/PROSPERO/display_record。php?RecordID=409534,标识符CRD42023409534。
    Interstitial lung disease (ILD) or pneumonitis caused by epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) or immune checkpoint inhibitors (ICI) is a major concern in the treatment of non-small cell lung cancer (NSCLC). Whether the addition of vascular endothelial growth factor (VEGF) and VEGF receptor (VEGFR) inhibitors can reduce the incidence of drug-induced ILD remains unclear. We conducted a systematic review to assess the incidence of ILD induced by EGFR-TKIs or ICIs in the presence or absence of VEGF/VEGFR inhibitors in relevant randomized trials between January 2009 and October 2023. The primary outcome was the odds ratio for the incidence of ILD in all patients worldwide and Asians. Secondary outcomes were the odds ratios (ORs) of the incidence at grade-3 or higher ILD in all patients worldwide and Asians. We identified 13 randomized studies, one sub-analysis in the EGFR-TKI group, and three randomized studies in the ICI group. In the EGFR-TKI group, the OR of ILD incidence at any grade with VEGF/VEGFR inhibitors was 0.54 (95% CI, 0.32-0.90; p = 0.02), which represented a significantly lower incidence than that without VEGF/VEGFR inhibitors. Contrarily, the OR of ILD incidence at grade ≥ 3 with VEGF/VEGFR inhibitors was 1.00 (95% CI, 0.43-2.36; p = 0.99). In all subjects in the ICI group, the OR of ILD incidence at any grade with VEGF/VEGFR inhibitors was 0.78 (95% CI, 0.51-1.21; p = 0.27). The systematic review demonstrated that the addition of VEGF/VEGFR inhibitors could reduce the incidence of drug-induced ILD at any grade caused by EGFR-TKI in patients with NSCLC but could not reduce that at grade ≥ 3. The ILD induced by ICIs remains undetermined owing to the limited number of randomized trials for which ILD data are available.
    UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=409534, identifier CRD42023409534.
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  • 文章类型: Journal Article
    背景:先前涉及曲妥珠单抗deruxtecan(DS-8201)的风险-收益分析的研究表明了这种治疗的益处,尽管它可能会增加某些患者间质性肺病(ILD)和/或肺炎的风险。本研究旨在评估DS-8201的安全性。
    方法:在四个电子数据库中搜索相关文章:PubMed,Embase,Cochrane图书馆,和ClinicalTrials.gov.截至2022年11月2日发布的所有报告都包括在内,研究类型仅限于临床试验;最后一次搜索更新至2023年1月10日.我们还通过Cochrane干预措施系统评价手册和非随机研究方法学指数工具评估了文献的质量。然后用R版本4.2.1进行荟萃分析。
    结果:本研究共纳入13篇文献报道的1428例患者。分析显示,最常见的所有级别治疗引起的不良事件(TEAE)是恶心和疲劳。最常见的3级或以上(≥3级)的TEAE是中性粒细胞减少症。全等级和≥3级TEAE的ILD和/或肺炎发生率分别为12.5%和2.2%,分别。
    结论:对临床试验中与DS-8201相关的TEAE发生率的全面总结为临床医生提供了重要的指导。最常见的TEAE是胃肠道反应和疲劳;同时,最常见的≥3级TEAE是血液学毒性.ILD和/或肺炎是与DS-8201相关的特定药物不良反应,其中医生应特别注意其较高的发病率和≥3级TEAE的发生率。
    BACKGROUND: Previous studies involving risk-benefit analysis of trastuzumab deruxtecan (DS-8201) have indicated the benefit of this treatment, although it may increase the risk of interstitial lung disease (ILD) and/or pneumonitis in certain patients. This study aimed to assess the safety of DS-8201.
    METHODS: A search was done for relevant articles in four electronic databases: PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov. All reports published up until November 2, 2022, were included, and study types were restricted to clinical trials; the last search was then updated to January 10, 2023. We also assessed the quality of the literature with the Cochrane Handbook for Systematic Reviews of Interventions and the Methodological Index for Non-Randomized Studies tool, and then performed a meta-analysis with R version 4.2.1.
    RESULTS: A total of 1428 patients reported in 13 articles were included in this study. The analysis revealed that the most common all-grade treatment-emergent adverse events (TEAEs) were nausea and fatigue. The most common TEAE of grade 3 or above (grade ≥3) was neutropenia. The incidences of ILD and/or pneumonitis for all-grade and grade ≥3 TEAEs were 12.5% and 2.2%, respectively.
    CONCLUSIONS: This comprehensive summary of the incidence of TEAEs associated with DS-8201 in clinical trials provides an important guide for clinicians. The most common TEAEs were gastrointestinal reactions and fatigue; meanwhile, the most common grade ≥3 TEAE was hematological toxicity. ILD and/or pneumonitis were specific adverse drug reactions associated with DS-8201, of which physicians should be particularly aware for their higher morbidity and rates of grade ≥3 TEAEs.
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  • 文章类型: Journal Article
    药物诱发的间质性肺病(DI-ILD)的发病率正在增加,由于在广泛的癌症和慢性炎症性疾病中使用了许多新药。即使对于不同个体的相同药物,DI-ILD的呈现和发作也是可变的。临床怀疑对于识别这些疾病至关重要,及时停药是结局的重要决定因素。
    这篇综述提供了全面和最新的流行病学摘要,危险因素,发病机制,诊断,治疗,和DI-ILD的预后。截至2023年9月,PubMed和Medline搜索的相关研究文章进行了筛选和总结。特异性药物包括免疫检查点抑制剂,CAR-T细胞疗法,甲氨蝶呤,和胺碘酮进行了详细讨论。考虑了药物基因组学分析对肺毒性风险的潜在作用。
    DI-ILD可能是社区中呼吸功能障碍的一个越来越重要的因素。这些情况会对生活质量和患者寿命产生负面影响,由于相关的呼吸损害以及对基础疾病的循证治疗的停止。这个临床难题与医学的所有领域有关,需要增加对药物相关肺毒性的了解和更高的警惕。
    UNASSIGNED: Drug-induced interstitial lung disease (DI-ILD) is increasing in incidence, due to the use of many new drugs across a broad range of cancers and chronic inflammatory diseases. The presentation and onset of DI-ILD are variable even for the same drug across different individuals. Clinical suspicion is essential for identifying these conditions, with timely drug cessation an important determinant of outcomes.
    UNASSIGNED: This review provides a comprehensive and up-to-date summary of epidemiology, risk factors, pathogenesis, diagnosis, treatment, and prognosis of DI-ILD. Relevant research articles from PubMed and Medline searches up to September 2023 were screened and summarized. Specific drugs including immune checkpoint inhibitors, CAR-T cell therapy, methotrexate, and amiodarone are discussed in detail. The potential role of pharmacogenomic profiling for lung toxicity risk is considered.
    UNASSIGNED: DI-ILD is likely to be an increasingly important contributor to respiratory disability in the community. These conditions can negatively impact quality of life and patient longevity, due to associated respiratory compromise as well as cessation of evidence-based therapy for the underlying disease. This clinical conundrum is relevant to all areas of medicine, necessitating increased understanding and greater vigilance for drug-related lung toxicity.
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  • 文章类型: Journal Article
    目的:放化疗(CRT)联合免疫检查点抑制剂(ICIs)是不可切除和局部晚期非小细胞肺癌患者的标准治疗方法。本研究旨在确定在CRT中添加ICI是否与肺炎风险增加相关。
    方法:PubMed,Embase,科克伦图书馆,和WebofScience数据库被搜索2015年1月1日至2023年7月31日之间发表的符合条件的研究。感兴趣的结果是肺炎的发生率。使用随机效应模型进行统计分析。
    结果:共纳入185项研究,共24,527名患者。CRT加ICIs的≥2级肺炎的合并率明显高于单独的CRT(29.6%;95%CI,25.7%-33.6%vs20.2%;95%CI,17.7%-22.8%;P<.0001),但不属于≥3级(5.7%;95%CI,4.8%-6.6%;5.6%;95%CI,4.7%-6.5%;0.1%CI-0.5%;P=.前瞻性研究的亚组分析结果,回顾性研究,亚洲和非亚洲研究,并发CRT(CCRT),和durvalumab合并与总体结果相当.然而,与单独使用CRT或cCRT加PD-L1抑制剂相比,CRT或cCRT加PD-1抑制剂不仅显着增加了≥2级肺炎的发生率,而且也增加了≥3级肺炎的发生率。
    结论:与单独的CRT相比,CRT后的durvalumab巩固似乎与中度肺炎的发生率较高相关,CRT+PD-1抑制剂可增加重度肺炎的风险.然而,这些发现基于观察性研究,需要在未来的大型头对头研究中进行验证.
    OBJECTIVE: Chemoradiotherapy (CRT) combined with immune checkpoint inhibitors (ICIs) is the standard of care for patients with unresectable and locally advanced non-small cell lung cancer. This study aimed to determine whether the addition of ICIs to CRT is associated with an increased risk of pneumonitis.
    METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies published between January 1, 2015, and July 31, 2023. The outcome of interest was the incidence rate of pneumonitis. A random-effects model was used for statistical analysis.
    RESULTS: A total of 185 studies with 24,527 patients were included. The pooled rate of grade ≥2 pneumonitis for CRT plus ICIs was significantly higher than that for CRT alone (29.6%; 95% CI, 25.7%-33.6% vs 20.2%; 95% CI, 17.7%-22.8%; P < .0001) but not that of grade ≥3 (5.7%; 95% CI, 4.8%-6.6% vs 5.6%; 95% CI, 4.7%-6.5%; P = .64) or grade 5 (0.1%; 95% CI, 0.0%-0.2% vs 0.3%; 95% CI, 0.1%-0.4%; P = .68). The results from the subgroup analyses of prospective studies, retrospective studies, Asian and non-Asian studies, concurrent CRT (cCRT), and durvalumab consolidation were comparable to the overall results. However, CRT or cCRT plus PD-1 inhibitors not only significantly increased the incidence of grade ≥2 but also that of grade ≥3 pneumonitis compared to CRT alone or cCRT plus PD-L1 inhibitors.
    CONCLUSIONS: Compared with CRT alone, durvalumab consolidation after CRT appears to be associated with a higher incidence of moderate pneumonitis and CRT plus PD-1 inhibitors with an increased risk of severe pneumonitis. Nevertheless, these findings are based on observational studies and need to be validated in future large head-to-head studies.
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  • 文章类型: Case Reports
    感染艾滋病毒的患者中的哥伦比亚分枝杆菌肺炎相对不常见,但与高死亡率相关,以及高误诊率和延误诊断率。临床宏基因组下一代测序(mNGS)可能具有准确和及时诊断的潜力。
    我们回顾性回顾了2019年1月至2020年12月期间浙江省三名感染了结肠支原体肺炎的HIV感染患者的医疗记录。在任何患者中均未发现特定的临床表现或放射学表现。与传统培养方法相比,在支气管肺泡灌洗液(BALF)上使用mNGS检测ColombienseM.利福布汀的联合治疗,克拉霉素,或者阿奇霉素,和乙胺丁醇不能及时缓解这3例患者的症状。在治疗的早期阶段,莫西沙星和利奈唑胺使用数周.所有3例患者的平均疗程接近17个月。
    我们建议早期BALFmNGS,以快速准确地诊断CD4计数低且症状持续时间长的HIV感染患者的结肠支原体肺炎。Further,莫西沙星和利奈唑胺在早期治疗中可能是有益的。
    UNASSIGNED: Mycobacterium colombiense pneumonia in HIV-infected patients is relatively unusual but is associated with a high mortality rate, as well as high rates of misdiagnosis and delayed diagnosis. Clinical metagenome next-generation sequencing (mNGS) may have potential for its accurate and timely diagnosis.
    UNASSIGNED: We retrospectively reviewed the medical records of three HIV-infected patients who presented with M. colombiense pneumonia in Zhejiang Province between January 2019 and December 2020. No specific clinical presentations or radiological manifestations were found in any of the patients. The detection of M. colombiense is 28-55 days earlier using mNGS on bronchoalveolar lavage fluid (BALF) compared to traditional culture methods. A combined treatment of rifabutin, clarithromycin, or azithromycin, and ethambutol did not provide timely relief of symptoms in these three patients. In the early stage of treatment, moxifloxacin and linezolid were used for several weeks. The average course of treatment for all three patients was close to 17 months.
    UNASSIGNED: We recommend early BALF mNGS for fast and accurate diagnosis of M. colombiense pneumonia in HIV-infected patients with low CD4 counts and long duration of symptoms. Further, moxifloxacin and linezolid may be beneficial in the early stage of treatment.
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  • 文章类型: Journal Article
    背景:老年人吸入性肺炎越来越常见,具有较高的护理负担和发病率。然而,其管理的临床能力尚未发展,和医疗保健专业人员为如何照顾这些有多模式治疗需求的患者而苦苦挣扎。因此,我们进行了一项范围审查,以调查已知的老年人吸入性肺炎治疗所需的临床能力,在临床实践中使用,教育,和未来的研究。
    方法:首先,我们根据初步搜索定义了吸入性肺炎.然后我们搜索了关于MEDLINE和CINAHL的文献,重点研究涉及65岁及以上被诊断为吸入性肺炎的患者。所有设置都包括在内,除了重症监护室。出版日期仅限于2011年1月至2022年7月,语言为英语和日语。提取的数据用于完善由日本吸入性肺炎专业团队间教育计划(JAPEP)制定的初步能力框架,以准备本研究。
    结果:纳入了九十九项研究。从这些研究中提取数据后,3个能力被重命名,并增加了3个新的能力,创建12项能力的列表。这些是诊断,治疗,燕子评估,基本条件管理,营养,口头管理,康复,多学科团队,决策,预防,预后,和姑息治疗。
    结论:我们的范围审查确定了治疗老年吸入性肺炎所需的12项临床能力,在短语“诊断”中概述,治疗和支持。我们鼓励医疗保健专业人员作为一个团队分享这些能力,以确定未满足的需求领域并改善他们的患者护理,强调支持性护理。
    BACKGROUND: Aspiration pneumonia in older adults is increasingly common, with a high care burden and morbidity. However, clinical competencies in its management have not been developed, and healthcare professionals struggle on how to care for these patients with multimodal treatment needs. Therefore, we conducted a scoping review to investigate what is known about the desired clinical competencies for the management of older adults with aspiration pneumonia, to utilise in clinical practice, education, and future research.
    METHODS: First, we defined aspiration pneumonia according to a preliminary search. We then searched the literature on MEDLINE and CINAHL, focusing on studies involving patients aged 65 years old and older diagnosed with aspiration pneumonia. All settings were included, with the exception of intensive care units. Publication dates were limited to January 2011 to July 2022 and languages to English and Japanese. The extracted data were used to refine the preliminary competency framework developed by the Japan Aspiration pneumonia inter-Professional team Educational Program (JAPEP) in preparation of this study.
    RESULTS: Ninety-nine studies were included. Following data extraction from these studies, 3 competencies were renamed, and 3 new competencies were added, to create a list of 12 competencies. These were Diagnosis, Treatment, Swallow Assessment, Underlying condition management, Nutrition, Oral management, Rehabilitation, Multidisciplinary team, Decision making, Prevention, Prognosis, and Palliative care.
    CONCLUSIONS: Our scoping review identified 12 clinical competencies required in the management of older adults with aspiration pneumonia, outlined in the phrase \'Diagnose, Treat and SUPPORT\'. We encourage healthcare professionals to share these competencies as a team to identify areas of unmet need and improve their patient care, with an emphasis on supportive care.
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  • 文章类型: Journal Article
    由免疫检查点抑制剂引起的肺毒性是临床医生的一个突出问题。临床实践指南(CPG)对于管理这些毒性至关重要。
    2022年10月对检查点相关肺毒性(ca-PT)的CPG进行了系统搜索。PubMed,Embase,科克伦图书馆,CINAHL,搜索了WebofScience。AGREEII和AGREE-REX用于评估CPG和建议的质量,分别。描述性统计,组内相关系数,Kruskal-Wallis(H)试验,和Spearman的相关性用于分析。P值<0.05被认为具有统计学意义。矩阵用于确定CPG之间的推荐差异。该研究的设计基于PRISMA2020清单进行系统评价。协议注册号:CRD42022358435。
    八个CPG(两个高质量,三个中等质量,和三个低质量)被确定。所有CPGs承保肺炎。一个CPG覆盖了胸腔积液和肺炎/SARs-CoV-2感染。三个CPG涵盖了结节病样反应。CPGs用于肺纤维化,气道疾病,细支气管炎,弥漫性肺泡损伤,不可用。没有基于前瞻性研究的CPG建议,没有一个被评价为高质量的。此外,建议并非针对组织病理学亚型.同意II的严格发展,“评估指南在收集科学证据方面的方法论方法和策略的领域,与AGREE-REX的“总体质量”肺炎建议密切相关,r=.952;P<.01。在高质量的CPG之间,大约73%的肺炎建议相似。大约16%至74%的低质量CPG与高质量CPG推荐的相似。
    迫切需要针对所有类型的ca-PT及其组织病理学亚型进行前瞻性设计的研究项目。由于现有CPG中缺乏高质量的建议,高质量CPG之间治疗建议的差异,以及高质量和低质量CPG之间存在的建议的相似性,在制定ca-PT治疗策略时,临床医师应全面评估和负责任地评价所有可用的CPG建议.
    UNASSIGNED: Pulmonary toxicities caused by immune checkpoint inhibitors are a prominent concern for clinicians. Clinical Practice Guidelines (CPGs) are critical for managing these toxicities.
    UNASSIGNED: A systematic search of CPGs on checkpoint-associated pulmonary toxicities (ca-PT) was conducted in October 2022. PubMed, Embase, Cochrane Library, CINAHL, and Web of Science were searched. AGREE II and AGREE-REX were used to appraise CPGs and recommendations quality, respectively. Descriptive statistics, intraclass correlation coefficient, Kruskal-Wallis (H) test, and Spearman\'s correlation were used for analyses. P-values < .05 were considered statistically significant. Matrices were used to determine recommendation differences between CPGs. The study\'s design was based on the PRISMA 2020 checklist for systematic reviews. Protocol registration number: CRD42022358435.
    UNASSIGNED: Eight CPGs (two high-quality, three moderate-quality, and three low-quality) were identified. All CPGs covered pneumonitis. One CPG covered pleural effusions and pneumonitis/SARs-CoV-2-infection. Three CPGs covered sarcoidosis-like-reactions. CPGs for pulmonary fibrosis, airway disease, bronchiolitis, and diffuse alveolar damage, were unavailable. No CPG recommendation was based on a prospective study, and none were appraised as high-quality. Also, recommendations were not specific to histopathologic subtypes. AGREE II\'s \"rigor of development,\" the domain that evaluates a guideline\'s methodological approach and strategies in gathering scientific evidence, correlated strongly with AGREE-REX\'s \"overall quality\" pneumonitis recommendations, r = .952; P < .01. Approximately 73% of recommendations on pneumonitis were similar between high-quality CPGs. About 16% to 74% of low-quality CPGs were similar to those recommended by high-quality CPGs.
    UNASSIGNED: Prospectively designed research projects focusing on all types of ca-PT and their histopathologic subtypes are urgently needed. Due to the lack of high-quality recommendations in available CPGs, the disparities in treatment recommendations between high-quality CPGs, and the similarities in recommendations that exists between high-quality and low-quality CPGs, clinicians should thoroughly assess and responsibly appraise all available CPG recommendations in formulating treatment strategies for ca-PT.
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  • 文章类型: Journal Article
    肺炎是接受确定性放化疗(CRT)的局部晚期非小细胞肺癌患者的常见并发症。目前尚不清楚CRT后肺炎的发病率是否存在种族差异。
    PubMed,Embase,科克伦图书馆,从2000年1月1日至2023年4月30日,搜索了WebofScience的合格研究。感兴趣的结果是肺炎的发生率。采用随机效应模型进行统计分析。该荟萃分析在PROSPERO(CRD42023416490)注册。
    共纳入248项研究,涉及28,267例患者。在没有免疫治疗的CRT研究中,亚洲患者的肺炎合并率显著高于非亚洲患者(所有级别:66.8%,95%CI:59.2%-73.9%与28.1%,95%CI:20.4%-36.4%;P<0.0001;≥2级:25.1%,95%CI:22.9%-27.3%与14.9%,95%CI:12.0%-18.0%;P<0.0001;≥3级:6.5%,95%CI:5.6%-7.3%与4.6%,95%CI:3.4%-5.9%;P=0.015;5级:0.6%,95%CI:0.3%-0.9%与0.1%,95%CI:0.0%-0.2%;P<0.0001)。关于CRT+免疫治疗的研究,亚洲患者的所有等级比率较高(74.8%,95%CI:63.7%-84.5%与34.3%,95%CI:28.7%-40.2%;P<0.0001)和≥2级(34.0%,95%CI:30.7%-37.3%与24.6%,95%CI:19.9%-29.3%;P=0.001)非亚洲患者肺炎,但≥3级和5级肺炎的发生率没有显着差异。亚组分析的结果通常与所有研究的结果相似。此外,与非亚洲研究相比,在亚洲研究中,接受≥20Gy的肺容积和平均肺剂量的合并中位数/平均值相对较低.
    亚洲患者的肺炎发生率可能高于非亚洲患者,这似乎是由于肺部对辐射的耐受性差。然而,这些发现是基于观察性研究,具有显著的异质性,并需要在未来重点关注该主题的大型前瞻性研究中进行验证。
    无。
    UNASSIGNED: Pneumonitis is a common complication for patients with locally advanced non-small cell lung cancer undergoing definitive chemoradiotherapy (CRT). It remains unclear whether there is ethnic difference in the incidence of post-CRT pneumonitis.
    UNASSIGNED: PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies from January 1, 2000 to April 30, 2023. The outcomes of interest were incidence rates of pneumonitis. The random-effect model was used for statistical analysis. This meta-analysis was registered with PROSPERO (CRD42023416490).
    UNASSIGNED: A total of 248 studies involving 28,267 patients were included. Among studies of CRT without immunotherapy, the pooled rates of pneumonitis for Asian patients were significantly higher than that for non-Asian patients (all grade: 66.8%, 95% CI: 59.2%-73.9% vs. 28.1%, 95% CI: 20.4%-36.4%; P < 0.0001; grade ≥2: 25.1%, 95% CI: 22.9%-27.3% vs. 14.9%, 95% CI: 12.0%-18.0%; P < 0.0001; grade ≥3: 6.5%, 95% CI: 5.6%-7.3% vs. 4.6%, 95% CI: 3.4%-5.9%; P = 0.015; grade 5: 0.6%, 95% CI: 0.3%-0.9% vs. 0.1%, 95% CI: 0.0%-0.2%; P < 0.0001). Regarding studies of CRT plus immunotherapy, Asian patients had higher rates of all-grade (74.8%, 95% CI: 63.7%-84.5% vs. 34.3%, 95% CI: 28.7%-40.2%; P < 0.0001) and grade ≥2 (34.0%, 95% CI: 30.7%-37.3% vs. 24.6%, 95% CI: 19.9%-29.3%; P = 0.001) pneumonitis than non-Asian patients, but with no significant differences in the rates of grade ≥3 and grade 5 pneumonitis. Results from subgroup analyses were generally similar to that from the all studies. In addition, the pooled median/mean of lung volume receiving ≥20 Gy and mean lung dose were relatively low in Asian studies compared to that in non-Asian studies.
    UNASSIGNED: Asian patients are likely to have a higher incidence of pneumonitis than non-Asian patients, which appears to be due to the poor tolerance of lung to radiation. Nevertheless, these findings are based on observational studies and with significant heterogeneity, and need to be validated in future large prospective studies focusing on the subject.
    UNASSIGNED: None.
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