基于临床特征的 PD-1/PD-L1 抑制剂在胃癌或胃食管交界处癌中的疗效：一项荟萃分析。
Efficacy of PD-1/PD-L1 inhibitors in gastric or gastro-oesophageal junction cancer based on clinical characteristics: a meta-analysis.
机构信息
Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
Department of Oncology, Jining NO.1 People's Hospital, Jining, 272000, Shandong, China.
出版信息
BMC Cancer. 2023 Feb 10;23(1):143. doi: 10.1186/s12885-023-10605-y.
PURPOSE
Programmed death-1 (PD-1) and its ligand (PD-L1) inhibitors have been reported in several clinical trials for gastric cancer and gastroesophageal junction cancer (GC/GEJC). We presently carried out a meta analysis to evaluate the potency of PD-1/PD-L1 inhibitors in advanced GC/GEJC individuals with different clinical features and to determine patients more probably benefiting from the treatment.
METHODS
Randomized clinical trials (RCTs) in databases that compared PD-1/PD-L1 inhibitors to chemotherapy in patients with GC/GEJC published before May 2022 were retrieved. Basic characteristics were extracted from the included studies as well as hazard ratios (HR) and 95 percent confidence intervals (CI) for all individuals and subgroups. The inverse variance weighting method was used to evaluate pooled treatment data.
FINDINGS
Four RCTs involving 2,253 individuals were included. The results suggested that PD-1/PD-L1 inhibitors substantially enhanced overall survival (OS) (HR, 0.91; CI 95%, 0.83-1.00; p = 0.04) but not progression free survival (PFS) (HR, 1.17; CI 95%, 0.83-1.64; p = 0.38) in GC/GEJC individuals compared with chemotherapy. Significantly improved OS was observed in individuals aged < 65 years (HR, 0.84; p = 0.003), and men (HR, 0.88; p = 0.02), but not in individuals aged ≥ 65 years (HR, 0.97; p = 0.62), and women (HR, 0.98; p = 0.82).
IMPLICATIONS
PD-1/PD-L1 inhibitors improve OS but not PFS compared with chemotherapy in GC/GEJC. Age and sex could be used to predict the treatment potency of PD-1/PD-L1 inhibitors in GC/GEJC.
目的
程序性死亡受体-1（PD-1）及其配体（PD-L1）抑制剂已在多项胃癌和胃食管交界癌（GC/GEJC）的临床试验中得到报道。我们目前进行了一项荟萃分析，以评估 PD-1/PD-L1 抑制剂在具有不同临床特征的晚期 GC/GEJC 患者中的疗效，并确定更可能从治疗中获益的患者。
方法
检索了截至 2022 年 5 月比较 PD-1/PD-L1 抑制剂与化疗治疗 GC/GEJC 患者的数据库中的随机临床试验（RCT）。从纳入的研究中提取基本特征以及所有个体和亚组的风险比（HR）和 95%置信区间（CI）。使用逆方差加权法评估汇总治疗数据。
结果
纳入了四项涉及 2253 名患者的 RCT。结果表明，与化疗相比，PD-1/PD-L1 抑制剂可显著提高 GC/GEJC 患者的总生存期（OS）（HR，0.91；CI 95%，0.83-1.00；p=0.04），但不能提高无进展生存期（PFS）（HR，1.17；CI 95%，0.83-1.64；p=0.38）。在年龄<65 岁（HR，0.84；p=0.003）和男性（HR，0.88；p=0.02）的患者中，观察到 OS 显著改善，但在年龄≥65 岁（HR，0.97；p=0.62）和女性（HR，0.98；p=0.82）的患者中未观察到 OS 改善。
结论
与化疗相比，PD-1/PD-L1 抑制剂可提高 GC/GEJC 的 OS，但不能提高 PFS。年龄和性别可用于预测 GC/GEJC 中 PD-1/PD-L1 抑制剂的治疗效果。
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