{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:56:49Z","timestamp":1791381409929,"version":"4.3.3"},"reference-count":27,"publisher":"Akademiai Kiado Zrt.","issue":"3","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMICR"],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Immune checkpoint inhibitors improve outcomes in solid tumors, but immune-related pneumonitis (irP) can lead to treatment interruption and even death; current stratification mainly relies on medical history and imaging, lacking reproducible organ-specific biomarkers. This prospective cohort study evaluated the association of baseline lower respiratory tract microbiota features and bacterial load with the risk of PD-1\/PD-L1-related irP. Bronchoalveolar lavage was performed before immunotherapy; 16S sequencing derived the Pathogen-Enrichment Score (PES), and quantitative PCR quantified total bacterial load. The primary endpoint was first occurrence of grade \u22652 irP within 6 months. Firth-corrected\u00a0multivariable logistic regression adjusted for prior thoracic radiotherapy, baseline interstitial lung disease, and recent antibiotic use. Of 294 evaluable cases, 34 developed grades \u22652 irP. Baseline total bacterial load was significantly higher in patients who later developed irP, showing a monotonic dose-response relationship with risk (nonlinearity\n                    <jats:italic>P<\/jats:italic>\n                    = 0.183); adjusted odds ratio = 1.58 per 1 log\n                    <jats:sub>10<\/jats:sub>\n                    copies\/mL (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.024). PES was also elevated (adjusted odds ratio = 1.43 per 1 SD,\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.033). The dysbiotic phenotype was characterized by reduced diversity and enrichment of\n                    <jats:italic>Streptococcus<\/jats:italic>\n                    ,\n                    <jats:italic>Veillonella<\/jats:italic>\n                    , and\n                    <jats:italic>Haemophilus<\/jats:italic>\n                    , genera commonly associated with oral microbiota and aspiration. Adding PES and\u00a0bacterial load to a clinical model improved discrimination (AUC 0.81 vs 0.73,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.019) and reclassification (categorical NRI = 0.24,\n                    <jats:italic>P<\/jats:italic>\n                    = 0.004). Event rates across risk strata were 2.24, 13.46, and\u00a032.65%. Baseline lower respiratory tract dysbiosis and elevated bacterial load indicate higher irP risk; adding these microbiologic measures to a clinical model improves prediction and risk stratification.\n                  <\/jats:p>","DOI":"10.1556\/030.2026.02909","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:48:32Z","timestamp":1777463312000},"page":"363-374","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Association of baseline lower respiratory tract microbiota composition and bacterial load with\u00a0the risk of PD-1\/PD-L1 inhibitor\u2013associated immune-related pneumonitis: A single-center prospective cohort study"],"prefix":"10.1556","volume":"73","author":[{"given":"Yun","family":"Wang","sequence":"first","affiliation":[{"name":"Oncology Department, The People's Hospital of Jiawang District of Xuzhou City, Xuzhou City, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Radiation Therapy Department, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henggen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Oncology Department, The People's Hospital of Pizhou, Pizhou City, Jiangsu Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"7","key":"B1","series-title":"JAMA Oncol","first-page":"1008","article-title":"Treatment-related adverse events of PD-1 and PD-L1 inhibitors in clinical trials: a systematic review and meta-analysis","volume":"5","author":"Wang Y","year":"2019","unstructured":"Wang Y, Zhou S, Yang F, Qi X, Wang X, Guan X, et\u00a0al. Treatment-related adverse events of PD-1 and PD-L1 inhibitors in clinical trials: a systematic review and meta-analysis. JAMA Oncol 2019; 5(7): 1008\u201319."},{"issue":"36","key":"B2","series-title":"J Clin Oncol","first-page":"4073","article-title":"Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update","volume":"39","author":"Schneider BJ","year":"2021","unstructured":"Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, et\u00a0al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. 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Ann Oncol 2022; 33(12): 1217\u201338."},{"issue":"1","key":"B4","series-title":"Chemotherapy","first-page":"1","article-title":"Risk of immune-related pneumonitis with PD-1\/PD-L1 inhibitors in different cancer types and treatment regimens: a systematic review and meta-analysis of 22 randomized controlled trials","volume":"68","author":"Han L","year":"2023","unstructured":"Han L, Li G, Li H, Zhao L Risk of immune-related pneumonitis with PD-1\/PD-L1 inhibitors in different cancer types and treatment regimens: a systematic review and meta-analysis of 22 randomized controlled trials. Chemotherapy 2023; 68(1): 1\u201315."},{"issue":"11","key":"B5","series-title":"Respiration","first-page":"1035","article-title":"Risk factors for immune checkpoint inhibitor-related pneumonitis in cancer patients: a systemic review and meta-analysis","volume":"101","author":"Zhou P","year":"2022","unstructured":"Zhou P, Zhao X, Wang G. 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Trends Microbiol 2019; 27(2): 105\u201317."}],"container-title":["Acta Microbiologica et Immunologica Hungarica"],"original-title":[],"link":[{"URL":"https:\/\/www.akjournals.com\/view\/journals\/030\/73\/3\/article-p363.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.akjournals.com\/downloadpdf\/journals\/030\/73\/3\/article-p363.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.akjournals.com\/downloadpdf\/journals\/030\/73\/3\/article-p363.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:25:15Z","timestamp":1791379515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.akjournals.com\/view\/journals\/030\/73\/3\/article-p363.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":27,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.1556\/030.2026.02909","relation":{},"ISSN":["1217-8950","1588-2640"],"issn-type":[{"value":"1217-8950","type":"print"},{"value":"1588-2640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}