■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.