PO.IM02.01 · 免疫学
肺结核作为肺癌患者分子特征与生存的修饰因素
Pulmonary tuberculosis as a modifier of molecular features and survival in lung cancer patients
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
肺结核（TB）可能通过慢性炎症和免疫失调影响肺肿瘤生物学，但在结核高负担地区，其临床与分子意义仍不甚明确。本研究旨在评估活动性和既往结核对非小细胞肺癌（NSCLC）患者分子特征与生存结局的影响。我们开展了一项回顾性观察性研究，纳入了2010年至2023年间在秘鲁利马国立肿瘤疾病研究所（INEN）确诊的219例NSCLC患者。根据临床与影像学资料，将患者分为活动性结核（a-TB，n=45）或既往结核（p-TB，n=174）。收集了临床、病理和分子变量。主要终点为总生存期（OS）；次要终点包括分子谱分布和无进展生存期（PFS）。a-TB组中位年龄为57岁，p-TB组为64岁。腺癌为主要组织学类型（94%）。整个队列中EGFR突变和ALK重排分别见于10.5%和4.1%的患者。PD-L1表达<1%较为常见（82.3%），并与既往结核显著相关（p=0.004）。在多变量分析中，缺乏驱动突变在a-TB组（HR 2.94；p=0.046）和p-TB组（HR 1.78；p=0.040）均独立地与较差的OS相关。在p-TB患者中，较长的结核暴露时间（>30年）与较差的OS相关（HR 1.47；p=0.039）。总之，肺结核，尤其是远期感染，与免疫抑制性肿瘤谱和NSCLC生存下降相关。这些发现提示结核病史可能作为肿瘤行为的生物学修饰因素，在地方性流行地区肺癌患者的预后评估和治疗规划中应予以考虑。
查看英文原文 English abstract
Pulmonary tuberculosis (TB) may influence lung tumor biology through chronic inflammation and immune dysregulation, but its clinical and molecular implications remain poorly understood in high TB-burden regions. This study aimed to evaluate the impact of active and prior TB on molecular characteristics and survival outcomes in patients with non-small cell lung cancer (NSCLC). We conducted a retrospective observational study including 219 patients diagnosed with NSCLC at the Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru, between 2010 and 2023. Patients were classified as having active TB (a-TB, n=45) or prior TB (p-TB, n=174) according to clinical and radiologic data. Clinical, pathological, and molecular variables were collected. The primary endpoint was overall survival (OS); secondary endpoints included molecular profile distribution and progression-free survival (PFS). The median age was 57 years in a-TB and 64 years in p-TB. Adenocarcinoma was the predominant histology (94%). EGFR mutations and ALK rearrangements were found in 10.5% and 4.1% of the overall cohort, respectively. PD-L1 expression <1% was frequent (82.3%) and significantly associated with prior TB (p=0.004). In multivariable analysis, the absence of a driver mutation was independently associated with inferior OS in both a-TB (HR 2.94; p=0.046) and p-TB (HR 1.78; p=0.040) groups. Among patients with p-TB, longer TB exposure (>30 years) was associated with poorer OS (HR 1.47; p=0.039). In conclusion, pulmonary tuberculosis, particularly remote infection, was linked to immunosuppressive tumor profiles and decreased survival in NSCLC. These findings suggest that TB history may act as a biological modifier of tumor behavior and should be considered in the prognostic assessment and therapeutic planning of lung cancer patients in endemic regions.
利益披露 Disclosure
C. Torres-Mallma, None..
R. Calle Valdez, None..
Y. Aroa Ferreyra, None..
N. Valdiviezo, None..
R. Ruiz, None..
O. Coanqui, None..
L. Mas, None.