BMC Pulmonary Medicine最新文献

Background: Asbestosis and idiopathic pulmonary fibrosis (IPF) share overlapping clinical and pathological features; however, differences in comorbidities and prognostic patterns between the two diseases remain poorly defined. This study aimed to compare comorbidities and prognostic factors associated with pulmonary fibrosis progression and mortality in asbestosis and IPF.

Methods: This prospective cohort study included 254 patients with asbestosis and 548 patients with IPF enrolled between 2016 and 2020, with follow-up through 2022. Outcomes included progressive pulmonary fibrosis (PPF) and all-cause mortality. Multivariable Cox models were applied to identify independent risk factors associated with these outcomes.

Results: Patients with asbestosis exhibited a higher comorbidity burden. Specifically, they more frequently had asthma, lung cancer, pleural disease, cardiovascular/cerebrovascular disease, and connective tissue disease, whereas emphysema was more common in IPF (all P < 0.05). Over a median follow-up of 44 months (IQR 24-61), IPF patients had a higher cumulative incidence of endpoint events than those with asbestosis. In asbestosis, a usual interstitial pneumonia (UIP) pattern on HRCT predicted disease progression. In IPF, risk factors for progression included hypoxemia, forced vital capacity (FVC) < 80%, and UIP compared with probable UIP. Interestingly, combined emphysema was protective against IPF progression. Mortality in asbestosis was associated with lung cancer, pulmonary hypertension (PH), and atrial fibrillation, whereas in IPF, it was linked to FVC < 80% and PH.

Conclusions: Asbestosis and IPF show distinct comorbidity patterns and prognostic drivers. IPF prognosis is mainly determined by fibrosis severity, while asbestosis mortality is driven largely by asbestos-related complications.

Background: Immunotherapy is the standard treatment for driver-negative advanced non-small cell lung cancer (NSCLC), but resistance remains common. Combining anti-angiogenic agents with immune checkpoint inhibitors (ICIs) may reverse resistance. This study evaluated the efficacy, safety, and optimal biomarkers of rechallenge with ICIs combined with anlotinib in advanced NSCLC patients previously treated with ICIs.

Methods: A total of 110 advanced NSCLC patients who progressed after prior ICI therapy were rechallenged with ICIs in combination with anlotinib. Primary endpoints included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and duration of response (DOR). Proteomics was performed on a subset of patients pre- and post-treatment to identify differentially expressed proteins. Patients were categorized into Responder (PFS ≥ 6 months) and Non-responder (PFS < 3 months) groups for proteomic comparison and functional validation of candidate proteins.

Results: Partial response (PR), stable disease (SD), and progressive disease (PD) were achieved in 20.9%, 57.3%, and 20.9% patients. ORR was 20.9% and disease control rate (DCR) was 78.2%, with median DOR of 7 months. Median PFS was 6.0 months and median OS was 16.0 months after rechallenge. Proteomic analysis revealed 91 significantly altered proteins post-treatment. ORM2 and SERPINA1 were hub proteins in the interaction network. External validation suggested a trend toward prolonged survival with high ORM2 and SERPINA1 expression.

Conclusion: Rechallenge with ICIs plus anlotinib demonstrated encouraging efficacy and safety in pretreated advanced NSCLC. Additionally, ORM2 and SERPINA1 were associated with response and survival outcomes in patients treated with the combined ICI + anlotinib regimen and may represent candidate biomarkers of clinical benefit, warranting prospective validation.

Introduction: Studies verifying the performance of antifibrotic drugs for the treatment of ANCA positive fibrotic ILD (ANCA-fILD) are lacking.

Materials and methods: This study assessed the clinical features of ANCA-fILD patients with or without add-on treatment with antifibrotic drugs. A retrospective study involving ANCA-positive patients treated from January 2012 to December 2023 at Peking Union Medical College Hospital was conducted, and a case‒control analysis was performed accordingly.

Results: A total of 105 ANCA-fILD patients were identified from 18,617 ANCA-positive patients treated from January 2012 to December 2023 at Peking Union Medical College Hospital; these patients were further divided into an add-on group (31 patients) and a non-add-on group (74 patients). On the basis of baseline FVC%pred matching (± 10%), 30 and 60 patients were ultimately included in the add-on and non-add-on groups, respectively. The decreases in pFVC (p = 0.03), FVC (p = 0.02), DLCO (p = 0.01), and pDLCO (p < 0.01) were less significant in the add-on group than in the non-add-on group. In the related sample analysis, the add-on group did not present significant differences in FVC (p = 0.47), pFVC (p = 0.53), DLCO (p = 0.90), and pDLCO (p = 0.43) between baseline and at the end of the 1-year follow-up, whereas the non-add-on group presented significant decreases in FVC (p < 0.01), pFVC (p < 0.01), DLCO (p < 0.0001) and pDLCO (p < 0.0001). The incidence rates of adverse events and acute exacerbations were similar between the two groups.

Conclusion: Add-on antifibrotic medications seem to effectively slow the deterioration of lung function in patients with ANCA⁺ fILD without causing any obvious new-onset adverse reactions.