背景:结核病(TB),一种高度传染性的呼吸道疾病,对全球健康构成重大威胁,世界卫生组织在2022年报告的发病率显着增加。特别是,结核病与非小细胞肺癌(NSCLC)之间的相互作用引起了人们的关注,特别是考虑到免疫检查点抑制剂(ICIs)在癌症治疗中的使用越来越多。这种相互作用可能会影响结核病诊断和重新激活,保证仔细检查。
方法:对厦门中山医院抗肿瘤治疗前T-SPOT阳性NSCLC患者的临床资料进行回顾性分析。复旦大学,从2021年1月1日至2022年12月31日。我们评估了这些患者中结核病再激活的发生率和治疗结果。此外,我们比较了ICIs和非ICIs治疗组的结核病活性差异.此外,我们观察了免疫疗法前后T-SPOT斑点计数的变化,分析它们与结核病活动和预后的关系。
结果:共有40例治疗前T-SPOT阳性的NSCLC患者纳入研究,ICIs治疗组26例,非ICIs治疗组14例。研究发现,两组在性别方面没有显着差异,年龄,舞台,组织学类型,性能状态,驱动基因表达,和远处转移。中位随访时间为10.0(6.0-14.5)个月,ICIs治疗组中有3例(11.5%)出现结核病活动,在ICIs治疗开始后2、3和12个月诊断。相反,在非ICIs治疗组中没有观察到结核病活动,两组间差异无统计学意义(P=0.186)。在接受ICIs治疗的32名患者中,斑点计数动态不同:4例(12.5%)显示增加,12例(37.5%)无变化,下降16例(50.0%)。在后续行动中,进展率(PD)为50.0%,75.0%,三组中有62.5%,分别为(P=0.527)。同样,死亡率为0%,25.0%,和25.0%,分别为(P=0.106)。有趣的是,在斑点计数减少的患者中,3例(18.75%)被诊断为活动性肺结核。
结论:对于接受ICIs治疗的T-SPOT反应阳性的NSCLC患者,我们的研究观察到活动性结核病的适应症.ICIs治疗后不同的T-SPOT斑点计数变化表明存在复杂的相互作用,可能将T-SPOT斑点计数减少与结核病再激活风险联系起来。这些初步发现强调了进一步研究的重要性,以更准确地评估T-SPOT在这种情况下的诊断效用。
BACKGROUND: Tuberculosis (TB), a highly contagious respiratory disease, presents a significant global health threat, with a notable increase in incidence reported by the WHO in 2022. Particularly, the interplay between TB and non-small cell lung cancer (NSCLC) gains attention, especially considering the rising use of immune checkpoint inhibitors (ICIs) in cancer treatment. This interplay may influence TB diagnostics and
reactivation, warranting a closer examination.
METHODS: A retrospective analysis was conducted on clinical data of NSCLC patients with positive T-SPOT results before undergoing anti-tumor treatment at Zhongshan Hospital (Xiamen), Fudan University, from January 1, 2021 to December 31, 2022. We assessed the incidence of tuberculosis
reactivation and treatment outcomes among these patients. Moreover, we compared the differences in tuberculosis activity between the ICIs and non-ICIs treatment groups. Additionally, we observed the changes in T-SPOT spot count before and after immunotherapy, analyzing their association with tuberculosis activity and prognosis.
RESULTS: A total of 40 NSCLC patients with positive T-SPOT results before treatment were included in the study, with 26 patients in the ICIs treatment group and 14 patients in the non-ICIs treatment group. The study found no significant differences between the two groups in terms of gender, age, stage, histological type, performance status, driver gene expression, and distant metastasis. With a median follow-up time of 10.0 (6.0-14.5) months, three cases (11.5%) in the ICIs treatment group developed tuberculosis activity, diagnosed at 2, 3, and 12 months after ICIs treatment initiation. Conversely, no tuberculosis activity was observed in the non-ICIs treatment group, and the difference between the two groups was not significant (P = 0.186). Among the 32 patients who received ICIs treatment, spot count dynamics were diverse: four cases (12.5%) showed an increase, 12 cases (37.5%) had no change, and 16 cases (50.0%) had a decrease. During the follow-up, the progression rate (PD) was 50.0%, 75.0%, and 62.5% in the three groups, respectively (P = 0.527). Similarly, the mortality rate was 0%, 25.0%, and 25.0%, respectively (P = 0.106). Interestingly, among the patients with decreased spot counts, three cases (18.75%) were diagnosed with active pulmonary tuberculosis.
CONCLUSIONS: For NSCLC patients with a positive T-SPOT response undergoing ICIs treatment, our study observed indications of active tuberculosis. The varied T-SPOT spot count changes post-ICIs treatment suggest a complex interaction, potentially linking T-SPOT spot count reduction to tuberculosis
reactivation risk. These preliminary findings underscore the importance of further research to more accurately assess T-SPOT\'s diagnostic utility in this context.