The interplay between the immune system and chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) is complex and multifaceted. In COPD, chronic inflammation and oxidative stress can lead to immune dysfunction that can exacerbate lung damage, further worsening the respiratory symptoms. In NSCLC, immune cells can recognise and attack the cancer cells, which, however, can evade or suppress the immune response by various mechanisms, such as expressing immune checkpoint proteins or secreting immunosuppressive cytokines, thus creating an immunosuppressive tumour microenvironment that promotes cancer progression and metastasis. The interaction between COPD and NSCLC further complicates the immune response. In patients with both diseases, COPD can impair the immune response against cancer cells by reducing or suppressing the activity of immune cells, or altering their cytokine profile. Moreover, anti-cancer treatments can also affect the immune system and worsen COPD symptoms by causing lung inflammation and fibrosis. Immunotherapy itself can also cause immune-related adverse events that could worsen the respiratory symptoms in patients with COPD-compromised lungs. In the present review, we tried to understand the interplay between the two pathologies and how the efficacy of immunotherapy in NSCLC patients with COPD is affected in these patients.
免疫系统与慢性阻塞性肺疾病（COPD）及非小细胞肺癌（NSCLC）之间的相互作用具有复杂性和多维度特征。在COPD中，慢性炎症与氧化应激可导致免疫功能失调，从而加剧肺组织损伤，进一步恶化呼吸系统症状。在NSCLC中，免疫细胞虽能识别并攻击癌细胞，但肿瘤细胞可通过多种机制逃逸或抑制免疫应答，例如表达免疫检查点蛋白或分泌免疫抑制性细胞因子，从而形成促进癌症进展与转移的免疫抑制性肿瘤微环境。COPD与NSCLC的共存状态使免疫反应更趋复杂：在合并两种疾病的患者中，COPD可通过降低或抑制免疫细胞活性、改变细胞因子谱等方式削弱机体对癌细胞的免疫应答。此外，抗肿瘤治疗亦可能通过引发肺部炎症与纤维化影响免疫系统，加剧COPD症状。免疫治疗本身也可能引发免疫相关不良事件，对已存在COPD肺功能损伤患者的呼吸症状造成进一步恶化。本文旨在系统阐述两种疾病间的相互作用机制，并探讨合并COPD的NSCLC患者接受免疫治疗的疗效影响因素。
肿瘤(癌症)患者之家