Objective: To explore the clinical and chest computed tomography (CT) features and the outcome of immune checkpoint inhibitor-related pneumonitis (CIP). Methods: Clinical and chest CT data of 38 CIP patients with malignant tumors from the Cancer Hospital, Chinese Academy of Medical Sciences between August 2017 and April 2021 were retrospectively reviewed, and the outcomes of pneumonitis were followed up. Results: The median time from the administration of immune checkpoint inhibitors (ICIs) to the onset of CIP was 72.5 days in 38 patients with CIP, and 22 patients developed CIP within 3 months after the administration of ICIs. The median occurrence time of CIP in 24 lung cancer patients was 54.5 days, earlier than 119.0 days of non-lung cancer patients (P=0.138), with no significant statistical difference. 34 patients (89.5%) were accompanied by symptoms when CIP occurred. The common clinical symptoms were cough (29 cases) and dyspnea (27 cases). The distribution of CIP on chest CT was asymmetric in 31 cases and symmetrical in 7 cases. Among the 24 lung cancer patients, inflammation was mainly distributed ipsilateral to the primary lung cancer site in 16 cases and diffusely distributed throughout the lung in 8 cases. Ground glass opacities (37 cases) and consolidation (30 cases) were the common imaging manifestations, and organizing pneumonia (OP) pattern (15 cases) was the most common pattern. In 30 CIP patients who were followed up for longer than one month, 17 cases had complete absorption (complete absorption group), and 13 cases had partial absorption or kept stable (incomplete absorption group). The median occurrence time of CIP in the complete absorption group was 55 days, shorter than 128 days of the incomplete absorption group (P=0.022). Compared with the incomplete absorption group, there were less consolidation(P=0.010) and CIP were all classified as hypersensitivity pneumonitis (HP) pattern (P=0.004) in the complete absorption group. Conclusions: CIP often occurs within 3 months after ICIs treatment, and the clinical and CT findings are lack of specificity. Radiologic features may have a profound value in predicting the outcome of CIP.
目的： 探讨免疫检查点抑制剂相关肺炎(CIP)的临床和胸部CT特点及炎症转归。 方法： 回顾性分析2017年8月至2021年4月中国医学科学院肿瘤医院收治的恶性肿瘤患者中38例CIP患者的临床和影像资料，随访观察炎症转归情况。 结果： 38例CIP患者自免疫检查点抑制剂(ICIs)用药至发生CIP的中位时间为72.5 d，22例患者于用药后3个月内发生CIP。24例肺癌患者中位CIP发生时间为54.5 d，早于非肺癌患者(119.0 d)，但差异无统计学意义(P＝0.138)。34例(89.5%)患者发生CIP时伴有症状，常见症状包括咳嗽(29例)、呼吸困难(27例)。CIP胸部CT炎症分布表现为不对称分布31例，对称分布7例。24例肺癌患者中，16例炎症主要分布在肺癌原发灶同侧，8例呈全肺弥漫分布。磨玻璃影(37例)和实变(30例)为常见的影像表现。CIP分类以机化性肺炎型最多见(15例)。在30例随访时间>1个月的患者中，17例CIP完全吸收(完全吸收组)，13例部分吸收或稳定(未完全吸收组)。完全吸收组中位CIP发生时间为55 d，短于未完全吸收组(128 d，P＝0.022)。与未完全吸收组相比，完全吸收组实变较少(P＝0.010)，CIP分类均为过敏性肺炎型(P＝0.004)。 结论： CIP多在ICIs用药后3个月内出现，临床和影像表现缺乏特异性。影像特点对预测炎症转归有重要意义。.
Keywords: Computed tomography; Immune checkpoint inhibitor; Pneumonitis; Treatment outcome.