Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (2): 29-35.doi: 10.6040/j.issn.1671-7554.0.2024.0832

• Clinical Medicine • Previous Articles     Next Articles

Predictive value of CD8+, IL-6, and PaO2 for immunotherapy-triggered radiation recall pneumonitis in unresectable stage ⅢB/C and IV non-small cell lung cancer

XU Nianxing, WEI Dong, QIAO Junjie, ZHAN Bingyan   

  1. Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266000, Shandong, China
  • Online:2025-03-10 Published:2025-03-07

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Abstract: Objective To explore predictive markers that can trigger radiation recall pneumonitis(RRP)in patients with unresectable stage ⅢB/C and Ⅳ non-small cell lung cancer(NSCLC)who receive immune checkpoint inhibitors(ICIs)following consolidative radiotherapy. Methods A retrospective analysis was conducted at Qingdao Municipal Hospital on patients with unresectable stage ⅢB/C and IV NSCLC who underwent radiotherapy followed by sequential ICI therapy from March 2020 to November 2023. Patients were divided into RRP and non-RRP groups. Clinical information, including gender, age, body mass index, performance status score, TNM stage, mean lung dose(MLD), V20, blood pressure, FEV1, FVC, FEV1/FVC, PaO2, PaCO2, procalcitonin, interleukin-6(IL-6), peripheral blood CD4+ and CD8+ T-cell counts were collected and assessed through Logistic regression and ROC curve analysis to evaluate risk factors. Results A total of 55 patients were included, with 30 in the non-RRP group(54.45%)and 25 in the RRP group(45.45%), including 3 critical RRP cases(3/55, 5.45%). There were no statistically significant differences between the two groups in terms of gender, age, BMI, performance status score, TNM stage, MLD, V20, blood pressure, FEV1, FVC, FEV1/FVC, PaCO2, procalcitonin, and CD4+ cell counts(P>0.05). The RRP group had significantly lower PaO2(P=0.007)and CD8+ T-cell counts(P=0.040), and higher IL-6 levels(P<0.001)compared to the non-RRP group. Both PaO2 and IL-6 showed high significance in univariate and multivariate analyses(P<0.01), while CD8+ T-cells were significant in multivariate analysis(P<0.05). In the ROC curve analysis, the AUC values ranked as PaO2 > IL-6 > CD8+ T-cells. Conclusion Patients with unresectable stage ⅢB/C and IV NSCLC undergoing radiotherapy followed by ICIs therapy have a low incidence of critical RRP, though a high incidence of RRP. Low PaO2, elevated IL-6 levels, and decreased peripheral blood CD8+ T-cell counts can serve as high-risk predictors for ICI-triggered RRP, exhibiting considerable predictive accuracy.

Key words: Non-small cell lung cancer, Immune checkpoint inhibitors, Radiation recall pneumonitis, CD8+, Interleukin-6

CLC Number: 

  • R734.2
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