ABSTRACT
Purpose@# The association between immune-related adverse events (irAEs) and survival outcomes in non–small cell lung cancer (NSCLC) patients treated with programmed death-(ligand) 1 [PD-(L)1] inhibitors remains controversial, partly due to variations in dealing with immortal-time bias (ITB). @*Materials and Methods@# We retrospectively enrolled 425 advanced NSCLC patients who received anti–PD-(L)1 monotherapy between January 2016 and June 2021, stratifying them into irAE (n=127) and non-irAE (n=298) groups. The primary endpoint was to assess the impact of irAEs on progression-free survival (PFS) and overall survival (OS). Landmark (2-, 3-, 6-, and 9-month) and time-dependent Cox analyses were performed to eliminate ITB. @*Results@# With a median follow-up of 38.8 months, the occurrence of overall irAEs was significantly associated with superior PFS (11.2 vs. 3.4 months, p < 0.001) and OS (31.4 vs. 14.0 months, p < 0.001), which persisted in landmark and time-dependent Cox analyses. For the main organ-specific irAEs, skin, thyroid, and hepatic irAEs, respectively, showed significantly improved survival compared to the non-irAE group, whereas pneumonitis did not. Single-organ irAEs had the best outcomes compared with multi-organ or no irAE, which also held across subgroups of skin, thyroid, and hepatic irAEs. Moreover, severe grade irAEs and immunotherapy discontinuation had a detrimental effect on survival, systemic steroid therapy showed little effect, while immunotherapy resumption had tolerable safety and a trend of improved survival. @*Conclusion@# After adequately adjusting ITB, the occurrence of overall irAEs predicts for favorable efficacy of anti–PD-(L)1 monotherapy in NSCLC, with better outcomes observed in patients with skin, thyroid, or hepatic irAEs, particularly those with single-organ involvement.
ABSTRACT
Objective@#To explore the epidemiological characteristics of injury among middle school students in Zhongshan city, Guangdong Province, and to provide evidence for appropriate student injury prevention strategies and injury monitoring programs.@*Methods@#The cluster random sampling method was used to collect injury information among 2 212 middle school students in urban and suburban areas of Zhongshan city. SPSS 22.0 was used for statistical analysis.@*Results@#Among all the 2 212 middle school students, the incidence of injury was 17.95%. The incidence of injuries (20.9%)and mutiple injuries(6.67%)among boys was higher than that of girls(15.42%,4.61%),and the differences were of statistical significance(χ2=11.21,4.45,P<0.05). The incidence of multiple injuries among junior high school students(6.70%) was higher than that among high school students(4.48%)(χ2=5.20，P<0.05). The injury occurred in the school (63.76%) was higher than that occurred outside of the school (36.24%). Most injures were more likely to occur in sports area in school(33.16%),and most injuries were found occured while doing physical activities(38.01%).@*Conclusion@#The prevention of injury among middle school students should focus on junior high school students and male students. School-based injury prevention and health education should focus on campus sports-related injury.