Lung cancer (LC) remains the leading cause of cancer-related mortality worldwide. In recent years, mortality rates have declined due to antismoking policies, earlier detection, and the advent of targeted therapies and immunotherapy, particularly for non-small cell lung cancer (NSCLC), which accounts for 85% of all cases. With improved survival, however, LC patients are increasingly exposed to competing causes of mortality, among which cardiovascular disease (CVD) is highly prevalent, affecting 30–50% of patients and contributing to nearly 30% of deaths. This burden reflects both shared risk factors and the cardiotoxic potential of radiotherapy, chemotherapy, and immunotherapy. Beyond acute adverse cardiovascular events during treatment, real-world data indicate that immune checkpoint inhibitors (ICIs) may also exert chronic cardiovascular effects, significantly accelerating the atherosclerotic process in multimorbid patients. These findings underscore the importance of accurate baseline assessment and aggressive management of cardiovascular risk factors in LC patients—particularly in the adjuvant and neoadjuvant settings, where longer survival is anticipated. Moreover, long-term monitoring should be implemented through a tailored, multiparametric strategy that integrates novel biomarkers and advanced artificial intelligence–assisted imaging techniques. Achieving this ambitious goal requires the close collaboration of a multidisciplinary team, with cardiologists playing a pivotal role. This review will address the complexity of LC patients, focusing on the interplay of cardio-immuno-metabolic factors, summarizing the cardiovascular impact of immunotherapy across metastatic, locally advanced, and perioperative settings, and outlining practical strategies for the management of these vulnerable patients.
肺癌仍是全球癌症相关死亡的首要原因。近年来，由于控烟政策、早期筛查的普及以及靶向治疗和免疫疗法的出现（尤其针对占所有病例85%的非小细胞肺癌），肺癌死亡率呈下降趋势。然而随着生存期延长，肺癌患者日益面临其他致死因素的竞争风险，其中心血管疾病尤为突出，约影响30%-50%的患者，导致近30%的死亡。这一负担既反映了肺癌与心血管疾病的共同危险因素，也体现了放疗、化疗及免疫疗法潜在的心脏毒性。除治疗期间发生的急性心血管不良事件外，真实世界数据显示免疫检查点抑制剂还可能产生慢性心血管影响，显著加速多病共存患者的动脉粥样硬化进程。这些发现凸显了对肺癌患者（特别是在预期生存期更长的辅助治疗与新辅助治疗阶段）进行精准基线评估并积极管控心血管危险因素的重要性。此外，需通过整合新型生物标志物与先进人工智能辅助成像技术的个体化多参数策略实施长期监测。实现这一目标需要多学科团队的紧密协作，其中心脏病学专家将发挥关键作用。本综述将剖析肺癌患者的复杂病情，聚焦心脏-免疫-代谢因素的相互作用，总结免疫疗法在转移性、局部晚期及围手术期场景中的心血管影响，并为这类脆弱患者的管理提出实用策略。
A New Era, New Risks: The Cardio-Oncology Perspective on Immunotherapy in Non-Small Cell Lung Cancer
肿瘤(癌症)患者之家