新辅助免疫疗法改善早期可切除非小细胞肺癌的治疗：一项系统评价和荟萃分析。
Neoadjuvant Immunotherapy Improves Treatment for Early Resectable Non-Small-Cell Lung Cancer: A Systematic Review and Meta-analysis.
作者信息
Dong Peng, Yan Yu, Yang Liyuan, Wu Danzhu, Wang Hui, Lv Yajuan, Zhang Jiandong, Yu Xinshuang
机构信息
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Taian, Shandong, China.
Clinical Medical College of Jining Medical University, Jining, Shandong Province, China.
出版信息
J Oncol. 2022 Sep 30;2022:2085267. doi: 10.1155/2022/2085267. eCollection 2022.
OBJECTIVE
Immunotherapy has shown better efficacy and less toxicity than chemotherapy in the treatment of non-small-cell lung cancer (NSCLC) at advanced stage. This study evaluates the safety and efficacy of neoadjuvant immunotherapy for resectable NSCLC.
METHODS
Literature examination was performed by searching the PubMed, the Cochrane Library, and Embase for articles evaluating the efficacy and safety of neoadjuvant immunotherapy for resectable NSCLC. The 95% confidence interval (CI) and effect sizes (ES) were evaluated. Heterogeneity and subgroup analysis were performed. Meta-analysis was carried out using Stata BE17 software.
RESULTS
In total, 678 patients from eighteen studies were recruited in this meta-analysis. The pathological complete response (pCR) and major pathological response (MPR) were used to evaluate the efficacy of neoadjuvant immunotherapy. Significantly higher MPR values were observed in neoadjuvant immunotherapy (MPR : ES = 0.44; 95% CI: 0.33-0.55; pCR : ES = 0.22; 95% CI: 0.15-0.30) compared with neoadjuvant chemotherapy (MPR < 25% and PCR : ES = 2%-15%). Treatment-related adverse events (TRAE), surgical resection rate, surgical delay rate, and incidence of surgical complications were used to evaluate the safety. In summary, ES values for the incidence of TRAE, incidence of surgical complications, and surgical delay rate were 0.4, 0.24, and 0.04, respectively, that were significantly lower than those for neoadjuvant chemotherapy (95% CI: 0.04-0.90; 0.22-0.75; and 0.01-0.10, respectively). The mean surgical resection rate of 89% was similar to the reported 75%-90% resection rate with neoadjuvant chemotherapy (OR = 7.61, 95% CI: 4.90-11.81).
CONCLUSION
Neoadjuvant immunotherapy is safe and effective for resectable NSCLC.
目的
在晚期非小细胞肺癌（NSCLC）的治疗中，免疫疗法已显示出比化疗更好的疗效和更低的毒性。本研究评估新辅助免疫疗法用于可切除NSCLC的安全性和疗效。
方法
通过检索PubMed、Cochrane图书馆和Embase，查找评估新辅助免疫疗法用于可切除NSCLC的疗效和安全性的文章，进行文献审查。评估95%置信区间（CI）和效应量（ES），进行异质性和亚组分析，使用Stata BE17软件进行荟萃分析。
结果
本荟萃分析共纳入了18项研究中的678例患者。采用病理完全缓解（pCR）和主要病理缓解（MPR）评估新辅助免疫疗法的疗效。与新辅助化疗（MPR＜25%且PCR：ES = 2% - 15%）相比，新辅助免疫疗法的MPR值显著更高（MPR：ES = 0.44；95% CI：0.33 - 0.55；pCR：ES = 0.22；95% CI：0.15 - 0.30）。采用治疗相关不良事件（TRAE）、手术切除率、手术延迟率和手术并发症发生率评估安全性。总体而言，TRAE发生率、手术并发症发生率和手术延迟率ES值分别为0.4、0.24和0.04，显著低于新辅助化疗（分别为95% CI：0.04 - 0.90；0.22 - 0.75；和0.01 - 0.10）。平均手术切除率为89%，与新辅助化疗报道的75% - 90%切除率相似（OR = 7.61，95% CI：4.90 - 11.81）。
结论
新辅助免疫疗法用于可切除NSCLC是安全有效的。
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