title: Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer.
abstract: BACKGROUND
  Data on characteristics, outcomes, and prognosis of advanced non-small-cell lung cancer (NSCLC) patients who develop pneumonitis during systemic anti-cancer therapy (pneumonitis) are currently lacking.
  
  
  METHODS
  We conducted a retrospective cohort study of 910 consecutive patients diagnosed with advanced NSCLC between January 2004 and January 2014. Of these, 140 patients were excluded because they did not receive systemic anti-cancer therapy at this hospital.
  
  
  RESULTS
  A total of 770 patients were included in the study, of whom 44 (6%) were diagnosed with pneumonitis. The mortality rate of pneumonitis was 36%. The incidence of pneumonitis was independently associated with pre-existing ILD (adjusted odds ratio, 2.99, P = 0.008), and survivors were significantly associated with younger age (P = 0.003) and radiographic non-acute interstitial pneumonia pattern (P = 0.004). In all patients, pneumonitis was identified as an independent predictor of overall survival (OS) (adjusted hazard ratio 1.53, 95% CI, 1.09-2.09, P = 0.015). Performance status was poor in 82% of survivors of pneumonitis; in 62% of survivors, the PS worsened after the pneumonitis improved. Additionally, 54% of survivors received no further systemic anti-cancer therapy after pneumonitis. The median survival time of survivors after pneumonitis was 3.5 months (95% CI, 2.3-7.2 months).
  
  
  CONCLUSIONS
  Our study indicated that 6% of patients with advanced NSCLC developed pneumonitis during systemic anti-cancer therapy. The early mortality rate of pneumonitis is high, and the survival and PS after pneumonitis is extremely poor. Additionally, pneumonitis has an adverse impact on the survival of patients with advanced NSCLC. These data should be considered for the management of pneumonitis, and we recommend that future work focuses on pneumonitis particularly to improve the survival of patients with advanced NSCLC.
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Fujimoto
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kato
authors.affiliation: Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Japan.|Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Shimizu
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kogo
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Teraoka
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D011014:Pneumonia / Q000139:chemically induced / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate