Clinical Utility and Therapeutic Strategy Value of Metagenomic Next-Generation Sequencing in Pulmonary Infection Among Cancer Patients

Yuepeng Cao,1,2,* Jing Huang,1,* Weiwei Wu,3,* Zeping Xu,1 Chao Wang,1 Xuhong Wu,1 Chuanfei Zhan,1 Jingjing Xing,1 Jia Liu,3 Miao Zhu,3 Shuliang Ma1 1Department of Critical Care Medicine, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu, People’s Republic of China; 2Department of Colorectal Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu, People’s Republic of China; 3Dinfectome Inc., Nanjing, Jiangsu, 210000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shuliang Ma, Department of Critical Care Medicine, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu, People’s Republic of China, Tel +86 83284766, Email mashuliang@163.comIntroduction: Cancer patients, particularly those with lung cancer, are highly susceptible to pulmonary infections due to both the disease itself and the immunosuppressive effects of treatments such as chemotherapy and immunotherapy. The objective of this study was to analyze pathogenic distribution characteristics of pulmonary infections in cancer patients and evaluated the guidance of metagenomic next-generation sequencing (mNGS) on clinical administration.Methods: This retrospective study included 66 samples from cancer patients. Pathogens in patient specimens, encompassing peripheral blood, bronchoalveolar lavage fluid (BALF), sputum, and other samples, were identified using both mNGS and culture methods.Results: Compared to culture methods, mNGS demonstrated a sensitivity of 95.5% across all samples. In terms of overall detections, Human gammaherpesvirus 4 was identified as the most frequently detected pathogen in cancer patients, while Escherichia coli and Candida albicans were ranked as the most common bacterial and fungal pathogens, respectively. During the perioperative period, non-surgical short-term treatment, non-surgical long-term treatment, and long-term treatment groups, Escherichia coli and Achromobacter xylosoxidans were all identified. Moreover, the treatment strategies for patients were timely adjusted based on the mNGS results, resulting in a significant improvement in clinical symptoms for 59.3% (16 out of 27) of the cancer patients.Conclusion: mNGS is an advanced approach for pathogen detection in cancer patients, with commendable diagnostic performance demonstrated. The results of mNGS contribute to the rapid modification of clinical medication, which may improve the survival rate of cancer patients.Keywords: cancer, metagenomic next-generation sequencing, pathogen, diagnostic performance