Long-term impacts of stomatitis and related lesions on clinical outcomes in lung cancer patients receiving chemotherapy and immunotherapy: Insights from a propensity-matched cohort study.

Abstract

e24205 Background: Stomatitis and related oral lesions are common adverse effects of antineoplastic therapies in lung cancer patients, but their long-term implications remain understudied. This study compares long-term outcomes between lung cancer patients with and without stomatitis who underwent chemotherapy and/or immunotherapy. Methods: Using data from the TriNetX federated health research network (88 healthcare organizations), we conducted a propensity score-matched comparative outcomes analysis. Cohort 1 included 8,350 adult patients with lung cancer (ICD-10: C34), stomatitis (ICD-10: K12), and antineoplastic therapy (ICD-10: Z51.1). Cohort 2 comprised 8,350 matched patients without stomatitis. Outcomes assessed post-index event (starting 1 day after therapy initiation, with no end date) included mortality, severe sepsis, malaise/fatigue, respiratory diseases, cardiac arrhythmias, pneumonia, dysphagia, and skin diseases. Analyses encompassed risk measures, Kaplan-Meier survival, and instance counts, excluding prior outcomes where specified. Results: After matching for demographics, comorbidities, and performance status, the stomatitis cohort exhibited a significantly higher hazard for mortality (HR 1.078, 95% CI 1.032-1.126, p < 0.001; median survival 807 vs. 899 days) and severe sepsis (HR 1.118, 95% CI 1.010-1.238, p = 0.032). Risks were elevated for dysphagia (RR 1.186, 95% CI 1.088-1.293, p < 0.001; HR 1.270, 95% CI 1.157-1.394, p < 0.001) and skin diseases (RR 1.119, 95% CI 1.046-1.196, p = 0.001; HR 1.235, 95% CI 1.139-1.338, p < 0.001). Stomatitis in lung cancer patients showed no significant effects on malaise/fatigue (RR 0.974, 95% CI 0.923-1.029, p = 0.346; HR 1.025, p = 0.167), respiratory diseases (RR 1.028, p = 0.394; HR 1.100, p = 0.522), cardiac arrhythmias (RR 0.967, p = 0.468; HR 1.021, p = 0.927), or pneumonia (RR 0.990, p = 0.731; HR 1.032, p = 0.666). Conclusions: Stomatitis in lung cancer patients on chemotherapy/immunotherapy is associated with increased long-term risks of mortality, severe sepsis, dysphagia, and skin diseases, highlighting the need for proactive oral care and monitoring to mitigate these effects and improve quality of life. Further prospective studies are warranted to explore causal mechanisms and interventions.