缺乏关于免疫检查点抑制剂（ICIs）在具有既往器官功能障碍的患者中的应用数据，因为这些患者经常被排除在临床试验之外。作者的目标是评估ICIs对慢性肾脏病（CKD）、肝硬化、慢性阻塞性肺疾病（COPD）和充血性心力衰竭（CHF）患者的影响。回顾性地获取了2015年1月1日至2021年1月1日期间，在作者所在机构开始ICIs治疗之前具有CKD（n = 90）、肝硬化（n = 20）、COPD（n = 142）或CHF（n = 82）的18岁以上实体器官恶性肿瘤患者的数据。采用描述性统计方法总结了患者特征、治疗特征、免疫相关不良事件（IrAEs）和临床结果。独立样本t检验或Wilcoxon秩和检验用于评估连续变量的差异；χ2检验或Fisher精确检验用于评估有无IrAEs的患者之间的分类变量差异。采用Kaplan-Meier曲线评估无进展生存期（PFS），采用log-rank检验评估PFS的差异。 在四个队列中，患者特征、治疗特征或临床结果（例如住院次数和PFS）在有IrAEs与无IrAEs的患者之间没有统计学上显著的差异。在CKD队列中，与无IrAEs的患者相比，有IrAEs的患者死亡风险显著降低（对于所有患者，52%与81%[p = 0.009]；对于接受无确切局部治疗的Ⅱ/Ⅲ期病人和Ⅳ期病人，53%与83%[p = 0.008]）；但在肝硬化、COPD和CHF队列中未观察到这种差异。在CHF和COPD队列中，接受ICIs治疗期间的心力衰竭和COPD急性加重的发生率和发生时间没有统计学上显著差异。本研究中IrAEs的发生率和发病时间与排除有重要合并症患者的临床试验之前报道的结果类似。 当前结果表明，ICIs在具有既往器官功能障碍的患者中耐受良好。 © 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

There are limited to no data regarding the use of immune checkpoint inhibitors (ICIs) in patients who have preexisting organ dysfunction because these patients are frequently excluded from clinical trials. The authors' objective was to evaluate the effects of ICIs in patients with chronic kidney disease (CKD), cirrhosis, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF).Data were obtained retrospectively for patients older than 18 years with solid organ malignancies who received at least one dose of an ICI between January 1, 2015, and January 1, 2021, and had either CKD (n = 90), cirrhosis (n = 20), COPD (n = 142), or CHF (n = 82) before ICI initiation at the authors' institution. Descriptive statistics were used to summarize patient characteristics, treatment characteristics, immune-related adverse events (IrAEs), and outcomes. An independent samples t-test or the Wilcoxon rank-sum test was used to assess differences in continuous variables; the χ2 test or the Fisher exact test was used to assess differences in categorical variables between patients with and without IrAEs. Progression-free survival (PFS) was assessed using Kaplan-Meier curves, and the log-rank test was used to assess differences in PFS.In all four cohorts, there were no statistically significant differences in patient characteristics, treatment characteristics, or outcomes, such as the number of hospitalizations and PFS, among those who experienced IrAEs compared with those who did not. In the CKD cohort, patients with IrAEs were significantly less likely to die than those without IrAEs (52% vs. 81% [p = .009] for all patients; 53% vs. 83% [p = .008] for patients with stage II/III disease who received no definitive local treatment and patients with stage IV disease); this difference was not observed in the cirrhosis, COPD, or CHF cohorts. There was no statistically significant difference in the number of heart failure and COPD exacerbations during the receipt of ICIs in the CHF and COPD cohorts, respectively. The incidence and time to onset of IrAEs in this study appeared to be similar to those reported previously in clinical trials that excluded patients with significant comorbidities.The current results demonstrate that ICIs are well tolerated by patients who have preexisting organ dysfunction.© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.