不可切除的Ⅲ期非小细胞肺癌患者的放化疗所致肺炎：系统文献回顾和荟萃分析

SCI

14 July 2022

Chemoradiation-Induced Pneumonitis in Patients with Unresectable Stage III Non-Small Cell Lung Cancer: A Systematic Literature Review and Metaanalysis

（IF: Lung Cancer, 6.081）

• Y. Kuang, C.M. Pierce, H-C. Chang, A.Z. Sosinsky, A.C. Deitz, S.M. Keller, A. Samkari, J. Uyei, Chemoradiation-Induced Pneumonitis in Patients with Unresectable Stage III Non-Small Cell Lung Cancer: A Systematic Literature Review and Meta-analysis, Lung Cancer (2022)

• Corresponding author:Christine M. Pierce, PhD，Merck & Co., Inc.，126 East Lincoln Ave., P.O. Box 2000,Rahway, New Jersey 07065 USA，christine.pierce@merck.com

Introduction 介绍

High-grade pneumonitis is a severe and potentially life-threatening adverse event associated with concurrent chemoradiation (cCRT) in patients with non-small cell lung cancer (NSCLC). The aim of this study was to summarize and quantify the incidence of severe (grade 3- 5) cCRT-induced pneumonitis in unresectable stage III NSCLC patients.

高级别肺炎是与非小细胞肺癌（NSCLC）患者同步放化疗（cCRT）相关的一种严重且可能危及生命的不良事件。本研究的目的是总结和量化不可切除的III期非小细胞肺癌患者中严重（3-5级）cCRT诱发肺炎的发病率。

Methods 方法

A systematic literature review and meta-analysis were performed in accordance with PRISMA guidelines. Published literature was searched for randomized controlled trials (RCTs), observational studies, and non-randomized trials from 2014 to April 2020. The primary outcome of interest was incidence of grade 3-5 pneumonitis.

我们根据PRISMA指南进行了系统的文献综述和荟萃分析。检索2014年至2020年4月发表的随机对照试验、观察性研究和非随机试验文献。感兴趣的主要结果是3-5级肺炎的发病率。

Results 结果

Included were 17 studies for the review and 11 for the meta-analysis (1,788 participants); all studies examined radiation-related pneumonitis (RP). The pooled incidence of cCRT-induced grade 3−5 RP in unresectable stage III NSCLC patients was estimated to be 3.62% [95% confidence interval (CI): 1.65−6.21] in RCTs, 5.98% [95% CI: 2.26−12.91] in observational studies, and 7.85% [95% CI: 4.08–13.10] in observational studies using platinum-based doublet chemotherapies.

纳入了17项审查研究和11项荟萃分析研究（1788名参与者）；所有研究均检查了放射性肺炎（RP）。在RCT中，cCRT诱导的3-5级RP在不可切除的III期 NSCLC患者中的汇总发生率估计为3.62% [95% 置信区间 (CI): 1.65-6.21]，在观察性研究中为5.98% [95% CI: 2.26-12.91 ]，在使用铂类双药化疗的观察性研究中为7.85% [95% CI: 4.08–13.10]。

Conclusions 结论

These results suggest the incidence of severe and fatal RP in patients with unresectable stage III NSCLC treated wih cCRT ranges from 3.62%–7.85%, with incidence varying by study design and chemotherapy regimen. Estimates of RP incidence were higher in the real-world setting compared to RCTs. These results can be used to contextualize the baseline risk of cCRT-induced pneumonitis in unresectable stage III NSCLC to better understand the adverse event of pneumonitis associated with novel immunotherapy treatments indicated for concomitant use with this modality.

这些结果表明，经cCRT治疗的不可切除的III期非小细胞肺癌患者的严重致命RP发生率在3.62%-7.85%之间，其发生率因研究设计和化疗方案而异。与随机对照试验相比，真实世界中RP发病率的估计值更高。这些结果可用于分析不可切除的III期非小细胞肺癌中cCRT诱发肺炎的基线风险，以更好地了解与这种方式同时使用的新型免疫治疗相关的肺炎不良事件。

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