Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China.
Hum Vaccin Immunother. 2021 May 4;17(5):1278-1287. doi: 10.1080/21645515.2020.1823779. Epub 2020 Oct 20.
Programmed cell death protein 1 (PD-1) inhibitors are the first-line treatment for advanced non-small-cell lung cancer (NSCLC) patients. However, their efficacy in metastatic NSCLC patients remains controversial.
The aim of our study was to evaluate the prognosis of advanced metastatic NSCLC patients treated with PD-1 inhibitors, and discuss the predictive effect of metastatic site on the long-term outcome.
The Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and PubMed databases were systematically screened up to February 10, 2020. Twenty-five eligible studies, involving 8,067 patients that assessed the impact of metastatic sites on survival outcome were incorporated in our study. Overall survival (OS) and progression-free survival (PFS) were described as hazard ratio (HR) with 95% confidence interval (CI).
Among the advanced NSCLC patients, the median proportion of brain, liver, bone, and adrenal gland metastases were 21%, 17%, 35%, and 21%, respectively. Patients with metastases to the brain, liver, and bone had worse OS compared to patients without these metastases when treated with PD-1 inhibitors. Similarly, patients with metastasis to the brain and liver were more likely to progress when treated with PD-1 inhibitors. Besides, patients with multiple metastatic sites had worse PFS compared to patients with one metastatic site, while no significant difference was found in terms of OS.
Based on the findings of our systematic review and meta-analysis, metastatic sites were independent predictors of the survival outcome for advanced NSCLC patients treated with PD-1 inhibitors.
程序性死亡蛋白 1（PD-1）抑制剂是晚期非小细胞肺癌（NSCLC）患者的一线治疗药物。然而，其在转移性 NSCLC 患者中的疗效仍存在争议。
本研究旨在评估 PD-1 抑制剂治疗晚期转移性 NSCLC 患者的预后，并探讨转移部位对长期结局的预测作用。
系统检索 Embase、Ovid Medline、Cochrane 中央对照试验注册库和 PubMed 数据库，检索时间截至 2020 年 2 月 10 日。纳入 25 项评估转移部位对生存结局影响的研究，共 8067 例患者。采用风险比（HR）及其 95%置信区间（CI）描述总生存（OS）和无进展生存（PFS）。
在晚期 NSCLC 患者中，脑、肝、骨和肾上腺转移的中位数比例分别为 21%、17%、35%和 21%。与无这些转移的患者相比，接受 PD-1 抑制剂治疗的脑、肝和骨转移患者 OS 更差。同样，接受 PD-1 抑制剂治疗的患者脑转移和肝转移更容易进展。此外，与仅有一个转移部位的患者相比，多个转移部位的患者 PFS 更差，但 OS 无显著差异。
基于本系统评价和荟萃分析的结果，转移部位是接受 PD-1 抑制剂治疗的晚期 NSCLC 患者生存结局的独立预测因素。
