Background: Immune checkpoint inhibitor-induced pancreatic injury (ICI-PI) is a rare immunotoxicity, with limited data on treatment and long-term outcomes.Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for studies reporting ICI-PI in patients with solid malignancies. ICI-PI was defined as pancreatic inflammation post-ICI exposure, diagnosed via radiologic changes or elevated lipase/amylase levels without other underlying causes. The CTCAE grading system was used. The primary objectives were to assess the frequency, severity, serum abnormalities, management, and long-term outcomes. We conducted a proportional single-arm meta-analysis with a random effects model.Results: The analysis included 25 retrospective studies involving 48,704 patients. Tumor types included thoracic/head and neck (38%), skin (26%), genitourinary/gynecological (18%), gastrointestinal (12%), and others (6%). The median age ranged from 56 to 73 years, with a follow-up from 2.5 to 45.9 months. ICI-PI occurred in 3.60% (95% CI: 1.64–6.28%) of patients, with grade ≥ 3 toxicity in 59.45% (95% CI: 35.32–81.37%). The frequency rates of ICI-PI were 1.99% for CTLA4 inhibitors, 5.01% for PD(L)1 inhibitors, and 7.44% for combination ICI therapy (p< 0.01). The median time to onset from treatment initiation ranged from 30 to 390 days, and symptom resolution ranged from 55 to 84 days. Management included corticosteroids (30.20%), intravenous fluids (22.82%), and hospitalization (30.46%). Chronic complications affected 63.54% (95% CI: 29.03–91.56%), including primarily diabetes mellitus (DM 89.45%; 95% CI: 61.88–100.0%) and exocrine pancreatic insufficiency (EPI 10.55%; 95%: 0.0–38.12%). ICI-PI recurrence occurred in 27.2% of those resuming ICI therapy. The objective response rate was 61.7% (95% CI: 55.08–68.17%).Conclusions: ICI-PI, though infrequent, is severe and predisposes patients to chronic complications, including DM and EPI.
背景：免疫检查点抑制剂诱导的胰腺损伤是一种罕见的免疫毒性反应，目前关于其治疗及长期结局的数据有限。 方法：系统检索PubMed、EMBASE和Cochrane图书馆中关于实体恶性肿瘤患者发生ICI-PI的研究。ICI-PI定义为使用ICI后出现的胰腺炎症，通过影像学改变或脂肪酶/淀粉酶水平升高（排除其他潜在病因）进行诊断。采用CTCAE分级系统进行评估。主要研究目标为评估ICI-PI的发生频率、严重程度、血清学异常、临床管理及长期结局。我们采用随机效应模型进行了比例单臂荟萃分析。 结果：分析共纳入25项回顾性研究，涉及48,704例患者。肿瘤类型包括胸部/头颈部肿瘤（38%）、皮肤肿瘤（26%）、泌尿生殖系统/妇科肿瘤（18%）、胃肠道肿瘤（12%）及其他类型（6%）。患者中位年龄范围为56至73岁，随访时间为2.5至45.9个月。ICI-PI发生率为3.60%（95% CI：1.64–6.28%），其中≥3级毒性反应占59.45%（95% CI：35.32–81.37%）。不同ICI方案的ICI-PI发生率分别为：CTLA4抑制剂1.99%、PD(L)1抑制剂5.01%、联合免疫治疗7.44%（p<0.01）。从治疗开始至发病的中位时间为30至390天，症状缓解时间为55至84天。临床管理措施包括使用皮质类固醇（30.20%）、静脉补液（22.82%）及住院治疗（30.46%）。慢性并发症发生率为63.54%（95% CI：29.03–91.56%），主要包括糖尿病（89.45%；95% CI：61.88–100.0%）和胰腺外分泌功能不全（10.55%；95% CI：0.0–38.12%）。重启ICI治疗的患者中复发率为27.2%。客观缓解率为61.7%（95% CI：55.08–68.17%）。 结论：ICI-PI虽不常见，但具有严重性，易导致糖尿病和胰腺外分泌功能不全等慢性并发症。
肿瘤(癌症)患者之家