脑转移状态与晚期肺癌免疫治疗疗效：系统评价和荟萃分析。
Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis.
机构信息
Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China.
The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China.
出版信息
Front Immunol. 2021 Jul 14;12:669398. doi: 10.3389/fimmu.2021.669398. eCollection 2021.
BACKGROUND
Brain metastases (BMs) indicate poor outcomes and are commonly excluded in immunotherapy clinical trials in advanced lung cancer; moreover, the effect of BM status on immunotherapy efficacy is inconsistent and inconclusive. Therefore, we conducted a meta-analysis to assess the influence of BM status on immunotherapy efficacy in advanced lung cancer.
METHODS
Electronic databases and all major conference proceedings were searched without language restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We extracted randomized clinical trials on lung cancer immunotherapy that had available overall survival (OS) and/or progression-free survival (PFS) data based on the BM status. All analyses were performed using random effects models.
RESULTS
Fourteen randomized clinical trials with 9,089 patients were identified. Immunotherapy conferred a survival advantage to BM patients [OS-hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.58-0.90; P = 0.004; and PFS-HR, 0.68; 95% CI, 0.52-0.87, P = 0.003]. Non-BM patients could also derive a survival benefit from immunotherapy (OS-HR, 0.76; 95% CI, 0.71-0.80; P <0.001; and PFS-HR, 0.68; 95% CI, 0.56-0.82, P <0.001). The pooled ratios of OS-HRs and PFS-HRs reported in BM patients non-BM patients were 0.96 (95% CI, 0.78-1.18; P = 0.72) and 0.97 (95% CI, 0.79-1.20; P = 0.78), respectively, indicating no statistically significant difference between them. Subsequent sensitivity analyses did not alter the results. Subgroup analyses according to tumor type, line of therapy, immunotherapy type, study design, and representation of BM patients reconfirmed these findings.
CONCLUSION
We demonstrated that BM status did not significantly influence the immunotherapy efficacy in lung cancer, suggesting that both BM and non-BM patients could obtain comparable benefits.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier (CRD42020207446).
背景
脑转移（BMs）预示着不良预后，且在晚期肺癌的免疫治疗临床试验中通常被排除在外；此外，BM 状态对免疫治疗疗效的影响不一致且尚无定论。因此，我们进行了一项荟萃分析，以评估 BM 状态对晚期肺癌免疫治疗疗效的影响。
方法
根据系统评价和荟萃分析的首选报告项目的指导原则，不限制语言地对电子数据库和所有主要会议记录进行了搜索。我们根据 BM 状态提取了有关肺癌免疫治疗的具有总生存（OS）和/或无进展生存（PFS）数据的随机临床试验。所有分析均采用随机效应模型进行。
结果
确定了 14 项包含 9089 名患者的随机临床试验。免疫治疗为 BM 患者带来了生存优势[OS-风险比（HR），0.72；95%置信区间（CI），0.58-0.90；P = 0.004；和 PFS-HR，0.68；95%CI，0.52-0.87，P = 0.003]。非 BM 患者也可从免疫治疗中获益（OS-HR，0.76；95%CI，0.71-0.80；P <0.001；和 PFS-HR，0.68；95%CI，0.56-0.82，P <0.001）。在 BM 患者和非 BM 患者中报告的 OS-HR 和 PFS-HR 的汇总比值分别为 0.96（95%CI，0.78-1.18；P = 0.72）和 0.97（95%CI，0.79-1.20；P = 0.78），表明两者之间无统计学差异。随后的敏感性分析并未改变结果。根据肿瘤类型、治疗线数、免疫治疗类型、研究设计和 BM 患者的代表性进行的亚组分析再次证实了这些发现。
结论
我们证明 BM 状态并未显著影响肺癌的免疫治疗疗效，这表明 BM 和非 BM 患者都可以获得相当的获益。
系统评价注册
Zotero 插件