Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer

Eun Hye Lee, Eun Young Kim, Sang Hoon Lee, Yun Ho Roh, Ah Young Leem, Joo Han Song, Song Yee Kim, Kyung Soo Chung, Ji Ye Jung, youngae kang, Young Sam Kim, Joon Chang, Moo Suk Park

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Abstract

Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. This retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) matched according to age, sex, histopathology, and stage. PJP definition was based on (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.06–3.63; p = 0.032) and CCRTx (OR: 2.09, 95% CI: 1.27–3.43; p = 0.004). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3%). Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. As these patients had a poor prognosis, clinicians should consider PJP prophylaxis for high-risk patients with lung cancer.

Original languageEnglish
Article number2094
JournalScientific reports
Volume9
Issue number1
DOIs
Publication statusPublished - 2019 Dec 1

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Pneumocystis carinii
Pneumocystis Pneumonia
Lung Neoplasms
Steroids
Odds Ratio
Pneumocystis
Confidence Intervals
Direct Fluorescent Antibody Technique
Lymphopenia
Esophagitis
Chemoradiotherapy
Therapeutics
Prednisolone
Case-Control Studies
Pneumonia
Radiotherapy
Multivariate Analysis
Polymerase Chain Reaction
Lung

All Science Journal Classification (ASJC) codes

  • General

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Lee, E. H., Kim, E. Y., Lee, S. H., Roh, Y. H., Leem, A. Y., Song, J. H., ... Park, M. S. (2019). Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer. Scientific reports, 9(1), [2094]. https://doi.org/10.1038/s41598-019-38618-3
Lee, Eun Hye ; Kim, Eun Young ; Lee, Sang Hoon ; Roh, Yun Ho ; Leem, Ah Young ; Song, Joo Han ; Kim, Song Yee ; Chung, Kyung Soo ; Jung, Ji Ye ; kang, youngae ; Kim, Young Sam ; Chang, Joon ; Park, Moo Suk. / Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer. In: Scientific reports. 2019 ; Vol. 9, No. 1.
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abstract = "Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. This retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) matched according to age, sex, histopathology, and stage. PJP definition was based on (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio [OR]: 1.96, 95{\%} confidence interval [CI]: 1.06–3.63; p = 0.032) and CCRTx (OR: 2.09, 95{\%} CI: 1.27–3.43; p = 0.004). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3{\%}). Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. As these patients had a poor prognosis, clinicians should consider PJP prophylaxis for high-risk patients with lung cancer.",
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Lee, EH, Kim, EY, Lee, SH, Roh, YH, Leem, AY, Song, JH, Kim, SY, Chung, KS, Jung, JY, kang, Y, Kim, YS, Chang, J & Park, MS 2019, 'Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer', Scientific reports, vol. 9, no. 1, 2094. https://doi.org/10.1038/s41598-019-38618-3

Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer. / Lee, Eun Hye; Kim, Eun Young; Lee, Sang Hoon; Roh, Yun Ho; Leem, Ah Young; Song, Joo Han; Kim, Song Yee; Chung, Kyung Soo; Jung, Ji Ye; kang, youngae; Kim, Young Sam; Chang, Joon; Park, Moo Suk.

In: Scientific reports, Vol. 9, No. 1, 2094, 01.12.2019.

Research output: Contribution to journalArticle

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AU - Lee, Eun Hye

AU - Kim, Eun Young

AU - Lee, Sang Hoon

AU - Roh, Yun Ho

AU - Leem, Ah Young

AU - Song, Joo Han

AU - Kim, Song Yee

AU - Chung, Kyung Soo

AU - Jung, Ji Ye

AU - kang, youngae

AU - Kim, Young Sam

AU - Chang, Joon

AU - Park, Moo Suk

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. This retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) matched according to age, sex, histopathology, and stage. PJP definition was based on (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.06–3.63; p = 0.032) and CCRTx (OR: 2.09, 95% CI: 1.27–3.43; p = 0.004). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3%). Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. As these patients had a poor prognosis, clinicians should consider PJP prophylaxis for high-risk patients with lung cancer.

AB - Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. This retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) matched according to age, sex, histopathology, and stage. PJP definition was based on (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.06–3.63; p = 0.032) and CCRTx (OR: 2.09, 95% CI: 1.27–3.43; p = 0.004). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3%). Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. As these patients had a poor prognosis, clinicians should consider PJP prophylaxis for high-risk patients with lung cancer.

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