新辅助免疫治疗联合化疗在局部晚期食管癌中的疗效与安全性：一项荟萃分析。

Efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy in locally advanced esophageal cancer: A meta-analysis.

作者信息

Wang Jincheng, Zhang Kun, Liu Tianzhou, Song Ying, Hua Peiyan, Chen Shu, Li Jindong, Liu Yang, Zhao Yinghao

机构信息

Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun, China.

Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, China.

出版信息

Front Oncol. 2022 Sep 5;12:974684. doi: 10.3389/fonc.2022.974684. eCollection 2022.

OBJECTIVE

The progress of neoadjuvant therapy for resectable locally advanced esophageal cancer has been stagnant. There has been much progress in immunotherapy for advanced esophageal cancer, but the efficacy and safety of neoadjuvant immunotherapy for resectable locally advanced esophageal cancer have not yet been definitively demonstrated.

METHODS

Original articles describing the safety and efficacy of neoadjuvant immunotherapy in resectable locally advanced esophagus published until July 2022 were retrieved from PubMed, Embase, and the Cochrane Library. The ratio (OR) and 95% confidence interval (CI) were calculated to conduct heterogeneity and subgroup analysis.

RESULTS

In total, 759 patients from 21 studies were enrolled. The effectiveness of neoadjuvant immunotherapy in combination with chemotherapy was evaluated using the major pathologic response (MPR) and pathologic complete response (PCR). In the enrolled patients, 677 were treated surgically and 664 achieved R0 resection. Major pathological remission was achieved in 52.0% (95% CI: 0.44-0.57) of patients on neoadjuvant immunotherapy combined with chemotherapy and complete pathological remission in 29.5% (95% CI: 0.25-0.32) of patients. The safety was primarily assessed by the incidence of treatment-related adverse events (TRAEs) and surgical resection rates. The incidence of TRAEs and the surgical resection rate combined ORs were 0.15 (95% CI: 0.09-0.22) and 0.86 (95% CI: 0.83-0.89), respectively.

CONCLUSION

Neoadjuvant immunotherapy combined with chemotherapy in locally advanced resectable esophageal cancer is effective and safe.

目的

可切除的局部晚期食管癌新辅助治疗进展停滞。晚期食管癌免疫治疗取得了很大进展，但可切除的局部晚期食管癌新辅助免疫治疗的疗效和安全性尚未得到明确证实。

方法

从PubMed、Embase和Cochrane图书馆检索截至2022年7月发表的描述新辅助免疫治疗在可切除的局部晚期食管癌中的安全性和疗效的原始文章。计算比值比（OR）和95%置信区间（CI）进行异质性和亚组分析。

结果

共纳入21项研究的759例患者。采用主要病理缓解（MPR）和病理完全缓解（PCR）评估新辅助免疫治疗联合化疗的有效性。在纳入的患者中，677例行手术治疗，664例实现R0切除。新辅助免疫治疗联合化疗的患者中，52.0%（95%CI：0.44-0.57）达到主要病理缓解，29.5%（95%CI：0.25-0.32）达到完全病理缓解。安全性主要通过治疗相关不良事件（TRAEs）的发生率和手术切除率进行评估。TRAEs的发生率和手术切除率的合并OR分别为0.15（95%CI：0.09-0.22）和0.86（95%CI：0.83-0.89）。