免疫检查点抑制剂治疗晚期上尿路上皮癌患者的疗效：系统评价和荟萃分析。
Outcome of patients with advanced upper tract urothelial carcinoma treated with immune checkpoint inhibitors: A systematic review and meta-analysis.
机构信息
Medicine and Surgery Department, University of Parma, Parma, Italy; Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
出版信息
Crit Rev Oncol Hematol. 2021 Mar;159:103241. doi: 10.1016/j.critrevonc.2021.103241. Epub 2021 Feb 2.
BACKGROUND
Advanced upper tract urothelial carcinoma (UTUC) has different molecular and genetic features from the commonest carcinoma of the bladder, suggesting a possible different sensitivity to immune-checkpoint inhibitors (ICI).
METHODS
A systematic review and meta-analysis of all relevant clinical studies including advanced UTUC patients treated with ICI was conducted according to PRISMA guidelines.
RESULTS
Six prospective trials for a total 2537 patients, including 396 (15.6 %) with advanced UTUC, were eligible for the analysis. In UTUC patients, the pooled ORR was 21.2 % (95 % CI, 12.5 %-33.7 %); the risk of death was reduced by 24 % over the standard platinum-based chemotherapy, but this was not statistically significant (hazard ratio = 0.76; 95 % confidence interval, 0.41-1.40; p = 0.37, χ2 = 3.28, p = 0.07; I2 = 70 %).
CONCLUSIONS
The current evidence does not support a statistically significant effect from ICI over the standard treatment for advanced UTUC patients. Properly performed pre-planned subgroup analyses from randomized clinical trials are eagerly awaited.
背景
高级上尿路尿路上皮癌（UTUC）与最常见的膀胱癌在分子和遗传特征上有所不同，这表明其对免疫检查点抑制剂（ICI）的敏感性可能不同。
方法
根据 PRISMA 指南，对所有包含接受 ICI 治疗的晚期 UTUC 患者的相关临床研究进行了系统评价和荟萃分析。
结果
共有 6 项前瞻性试验，总计 2537 例患者，其中 396 例（15.6%）为晚期 UTUC，符合分析标准。在 UTUC 患者中，汇总的客观缓解率为 21.2%（95%CI，12.5%-33.7%）；ICI 治疗组死亡风险降低 24%，但无统计学意义（风险比=0.76；95%置信区间，0.41-1.40；p=0.37，χ2=3.28，p=0.07；I2=70%）。
结论
目前的证据并不支持 ICI 对晚期 UTUC 患者标准治疗具有统计学显著效果。迫切需要从随机临床试验中进行适当的预先计划的亚组分析。
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