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2025 ; 25
(1
): 1636
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The value of second-generation gene sequencing in lung cancer immunotherapy with
concurrent infections
#MMPMID41131518
Zhang Y
; Zhang Q
; Wang L
; Hu Y
BMC Cancer
2025[Oct]; 25
(1
): 1636
PMID41131518
show ga
OBJECTIVE: To collect clinical baseline data of patients with lung cancer and
infection, explore the association between clinical characteristics and infection
characteristics between the immunotherapy group and the non-immunotherapy group.
At the same time, analyze the distribution of pathogens in patients, compare
whether there are differences in pathogen distribution between the two groups,
and thus explore the diagnostic value of metagenomic next-generation sequencing
for patients with lung cancer immunotherapy and infection. METHODS: A total of
107 patients with lung cancer and infection treated at Jingzhou First People?s
Hospital from December 2022 to July 2025 were included in the study. They were
divided into an immunotherapy group (40 cases) and a non-immunotherapy group (67
cases) based on whether they received immunotherapy. All patients underwent
electronic bronchoscopy and mNGS testing. The pathogen detection results and
various clinical baseline information of the enrolled patients were collected to
explore the association between infection characteristics and clinical
characteristics in the two groups and to compare whether there were differences
in pathogen distribution between the two groups. RESULTS: In terms of clinical
manifestations, the proportion of patients with fever was higher in the
immunotherapy group than in the non-immunotherapy group. The length of hospital
stay and hospitalization costs were higher in the immunotherapy group than in the
non-immunotherapy group, with statistically significant differences (P?0.05).
In terms of laboratory indicators, patients in the immunotherapy group had higher
levels of D-dimer and inflammatory markers (CRP, PCT, IL-6) than those in the
non-immunotherapy group, while albumin and hemoglobin levels were lower, with
statistically significant differences (P?0.05). In the immunotherapy group, 11
cases of pure bacterial infection, 0 cases of pure fungal infection, 2 cases of
pure viral infection, and 25 cases of mixed infection were detected. In the
non-immunotherapy group, there were 5 cases of pure bacterial infection, 6 cases
of pure fungal infection, 1 case of pure viral infection, and 51 cases of mixed
infection. We found that the detection rate of pure bacterial infection was
higher in the immunotherapy group than in the non-immunotherapy group (X² =
7.907, P?=?0.005?0.05), with the tuberculosis bacillus infection rate
significantly higher in the immunotherapy group than in the non-immunotherapy
group (X² = 5.738, P?=?0.017?0.05). Among mixed infections, the detection rate
of fungal mixed infections was higher in the immunotherapy group than in the
non-immunotherapy group (X² = 7.474, P?=?0.006?0.05). with the immunotherapy
group showing significantly higher infection rates for Pneumocystis jirovecii (X²
= 4.292, P?=?0.038?0.05) and Aspergillus terreus (X² = 4.485, P?=?0.034?0.05)
compared to the non-immunotherapy group, with statistically significant
differences. The detection rate of mixed bacterial infections in the
non-immunotherapy group was higher than that in the immunotherapy group (X² =
8.568, P?=?0.003?0.05). The detection rates of single bacterial and viral
infections, as well as other mixed infections, in the immunotherapy group were
not significantly different from those in the non-immunotherapy group (P?>?0.05).
CONCLUSION: The incidence of bacterial infections and mixed fungal infections
increased in lung cancer patients after immunotherapy. Among them, the detection
rates of Mycobacterium tuberculosis, Pneumocystis jirovecii, and Aspergillus
fumigatus were significantly higher in the immunotherapy group than in the
non-immunotherapy group. The detection rate of bacterial mixed infections was
higher in the non-immunotherapy group than in the immunotherapy group. In the
immunotherapy group, bacterial infections were primarily caused by Mycobacterium
tuberculosis and Streptococcus pneumoniae, fungal infections were primarily
caused by Aspergillus fumigatus and Pneumocystis jirovecii, and viral infections
were primarily caused by Epstein-Barr virus (EBV). In the non-immunotherapy
group, bacterial infections were primarily caused by Pseudomonas aeruginosa and
Haemophilus influenzae, fungal infections were primarily caused by Aspergillus
fumigatus, Pneumocystis jirovecii, and Aspergillus flavus, and viral infections
were primarily caused by EB virus and influenza A virus H1N1. Additionally, mNGS
demonstrated good applicability in the population undergoing immunotherapy for
lung cancer and had a significant impact on treatment outcomes.