Department of Medical Oncology, Yantaishan Hospital, Yantai 264003, China.
Public Health Division, Yantaishan Hospital, Yantai 264003, China.
Comput Math Methods Med. 2022 Aug 23;2022:6998090. doi: 10.1155/2022/6998090. eCollection 2022.
To systematically assess the clinical effect and survival time of immune checkpoint inhibitor (ICIs) in advanced gastric cancer (GC) and adverse reactions to provide evidence-based medicine for its enhancement and adoption.
PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network database (CNKI), China VIP database, Wanfang database, and China Biomedical Literature Database (CBM) online database were searched for randomized controlled trials (RCT) of immuno-checkpoint inhibitors in advanced GC therapy. Retrieval time was limited to the period from the date the database was established to present. Separately, two researchers gathered the data. Statistical software RevMan5.4 was used to estimate bias risk according to the Cochrane Handbook 5.3 standard.
The computer database retrieved 1723 articles, and 465 articles were eliminated when repeated studies were removed. After screening the titles and abstracts of 287 articles, 124 articles were contained after eliminating irrelevant studies, reviews, case reports, and no control literature. After carefully reading 108 studies with insufficient data and no major outcome markers, 6 RCTs were eventually contained. 4 articles compared the levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) after treatment. The result indicated that the levels of serum CEA and CA199 in the study group were notably lower, and the difference was statistically significant ( < 0.05). The immune function indexes after treatment were compared, suggesting that the improvement of immune function indexes in the study group was notably better, and the difference was statistically significant ( < 0.05). Three clinical trials reported the median progression-free survival (PFS). The PFS of the study group was notably longer after treatment, and the difference was statistically significant ( < 0.05). The occurrence of adverse reactions after treatment was analyzed by meat, and all the literatures were analyzed. No notable differences were observed in the incidence of adverse reactions.
ICIs associated with chemotherapy is effective when treating GC, which can effectively promote the disease control rate of patients, enhance immune function, reduce the level of tumor markers, and prolong survival time. The safety is controllable, which is worth popularizing in clinical practice. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify it.
系统评估免疫检查点抑制剂（ICI）在晚期胃癌（GC）中的临床疗效和生存时间以及不良反应，为其增效减毒提供循证医学依据。
计算机检索 PubMed、EMBASE、ScienceDirect、Cochrane Library、中国知网数据库（CNKI）、维普数据库、万方数据库、中国生物医学文献数据库（CBM），搜集免疫检查点抑制剂治疗晚期 GC 的随机对照试验（RCT），检索时限均为建库至 2023 年 5 月。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 RevMan5.4 软件进行 Meta 分析。
初检出文献 1723 篇，剔除重复文献后，剩余 287 篇。进一步阅读题目和摘要后，排除不相关研究、综述、病例报告及无对照文献，剩余 124 篇。仔细阅读后，剔除数据资料不完整及无主要结局指标的研究 108 篇，最终纳入 6 篇 RCT。4 篇文献比较了治疗后患者癌胚抗原（CEA）、糖类抗原 199（CA199）水平，结果显示研究组血清 CEA、CA199 水平均明显降低，差异均有统计学意义（ < 0.05）。治疗后免疫功能指标比较，结果显示研究组免疫功能指标改善情况明显优于对照组，差异均有统计学意义（ < 0.05）。3 项临床研究报道了中位无进展生存期（PFS），结果显示研究组患者治疗后 PFS 明显延长，差异有统计学意义（ < 0.05）。采用梅脱法分析治疗后不良反应的发生情况，纳入所有文献进行分析，结果显示两组不良反应发生率比较差异无统计学意义。
ICI 联合化疗治疗 GC 有效，可有效提高患者的疾病控制率，增强免疫功能，降低肿瘤标志物水平，延长生存时间，且安全性可控，值得在临床实践中推广应用。但仍需要更多高质量、更长干预时间的研究和随访进一步验证。
