Wan Linghong, Wang Zhi, Xue Jinmin, Yang Huaju, Zhu Yuxi
Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Oncology, Jinshan Hospital of The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Transl Cancer Res. 2020 Sep;9(9):5437-5449. doi: 10.21037/tcr-20-1131.
Cancer is one of the world's top three causes of death now. Immune checkpoint inhibitors (ICIs) show encouraging ability to treat some malignancies due to its long-term efficacy and low side effects. However, the predictive biomarker of the immunotherapy efficacy has been inconclusive. Thus, exploring new biomarkers is important.
A meta-analysis was conducted to evaluate whether tumor mutation burden (TMB) could be a predictive biomarker of the efficacy of ICIs. Using the PubMed and Cochrane Library databases, we searched for articles about TMB and the prognosis of patients with multiple malignancies conducted from 1984 to May 22, 2020. We identified the relationship between TMB and the clinical efficacy of ICIs by using Stata 12.1 software.
Eighteen articles with a total of 4,535 patients were included in this meta-analysis. Results showed that high-TMB patients had better progression-free survival (PFS) than low-TMB patients with cancer treated with ICIs (HR =0.45; 95% CI: 0.36-0.56, P=0.002). Moreover, high-TMB patients had longer overall survival (OS) than low-TMB patients. However, the heterogeneity was extremely high, so the result regarding OS was meaningless (HR =0.56; 95% CI: 0.44-0.70, P=0.000, I-squares: 72.6%).
Our study indicates that high TMB is associated with better PFS. Thus, TMB can be considered as a predictive marker of PFS of patients treated with ICIs in the future.
癌症是目前全球三大死因之一。免疫检查点抑制剂（ICIs）因其长期疗效和低副作用，在治疗某些恶性肿瘤方面显示出令人鼓舞的能力。然而，免疫治疗疗效的预测生物标志物尚无定论。因此，探索新的生物标志物很重要。
进行一项荟萃分析，以评估肿瘤突变负荷（TMB）是否可作为ICIs疗效的预测生物标志物。利用PubMed和Cochrane图书馆数据库，我们检索了1984年至2020年5月22日期间关于TMB和多种恶性肿瘤患者预后的文章。我们使用Stata 12.1软件确定TMB与ICIs临床疗效之间的关系。
本荟萃分析纳入了18篇文章，共4535例患者。结果显示，接受ICIs治疗的高TMB癌症患者的无进展生存期（PFS）优于低TMB患者（HR =0.45；95%CI：0.36 - 0.56，P =0.002）。此外，高TMB患者的总生存期（OS）长于低TMB患者。然而，异质性极高，因此关于OS的结果无意义（HR =0.56；95%CI：0.44 - 0.70，P =0.000，I²：72.6%）。
我们的研究表明，高TMB与更好的PFS相关。因此，TMB未来可被视为接受ICIs治疗患者PFS的预测标志物。
