Kim Jung Han, Kim Hyeong Su, Kim Bum Jun
Division of Hemato-Oncology, Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul 07441, Republic of Korea.
Oncotarget. 2017 Jun 28;8(54):93149-93155. doi: 10.18632/oncotarget.18703. eCollection 2017 Nov 3.
Immune checkpoint inhibitors (ICIs) have emerged as a new treatment option for patients with advanced non-small-cell lung cancer (NSCLC). Some studies with ICIs in NSCLC suggested that smoking history was associated with improved survival outcomes. We conducted this meta-analysis to investigate if survival benefits of ICIs in patients with advanced NSCLC are different according to smoking status. Electronic databases were searched for eligible studies. We included randomized controlled trials with the data of survival outcomes and extracted progression-free survival (PFS) or overall survival (OS) stratified by smoking status. From 6 studies, 2,389 ever-smokers and 413 never-smokers were included in the meta-analysis. In first-line treatment setting, ICIs tended to improve PFS in patients with smoking history (HR = 0.85 [95% CI, 0.71-1.10], = 0.07). For never-smokers with advanced NSCLC, chemotherapy, not ICIs, was significantly associated with improvement of PFS (HR = 2.30 [95% CI, 1.23-4.28], = 0.009). In more than second-line setting, ICIs significantly prolonged OS over that with chemotherapy in ever-smokers (HR = 0.70 [95% CI, 0.63-0.79], < 0.00001). For never-smokers with NSCLC, however, ICIs failed to significantly improve OS (HR = 0.79 [95% CI, 0.59-1.06], = 0.12). In conclusion, this meta-analysis indicates that ICIs can prolong survival over that with chemotherapy in ever-smokers with advanced NSCLC. However, ICIs failed to improve survival in never-smokers. These results suggest that smoking status may be a predictive marker for survival benefits to ICIs.
免疫检查点抑制剂（ICIs）已成为晚期非小细胞肺癌（NSCLC）患者的一种新的治疗选择。一些关于ICIs用于NSCLC的研究表明，吸烟史与生存结果改善相关。我们进行这项荟萃分析，以调查晚期NSCLC患者中ICIs的生存获益是否因吸烟状态而异。检索电子数据库以查找符合条件的研究。我们纳入了具有生存结果数据的随机对照试验，并提取了按吸烟状态分层的无进展生存期（PFS）或总生存期（OS）。从6项研究中，2389名曾经吸烟者和413名从不吸烟者被纳入荟萃分析。在一线治疗中，ICIs倾向于改善有吸烟史患者的PFS（HR = 0.85 [95% CI，0.71 - 1.10]，P = 0.07）。对于晚期NSCLC的从不吸烟者，化疗而非ICIs与PFS改善显著相关（HR = 2.30 [95% CI，1.23 - 4.28]，P = 0.009）。在二线以上治疗中，ICIs使曾经吸烟者的OS显著长于化疗（HR = 0.70 [95% CI，0.63 - 0.79]，P < 0.00001）。然而，对于NSCLC的从不吸烟者，ICIs未能显著改善OS（HR = 0.79 [95% CI，0.59 - 1.06]，P = 0.12）。总之，这项荟萃分析表明，ICIs可使晚期NSCLC的曾经吸烟者的生存期长于化疗。然而，ICIs未能改善从不吸烟者的生存。这些结果表明，吸烟状态可能是ICIs生存获益的预测标志物。
