免疫检查点抑制剂相关肺癌患者的呼吸系统疾病：一项随机对照试验的荟萃分析。
Immune checkpoint inhibitors related respiratory disorders in patients with lung cancer: A meta-analysis of randomized controlled trials.
机构信息
Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China.
出版信息
Front Immunol. 2023 Feb 28;14:1115305. doi: 10.3389/fimmu.2023.1115305. eCollection 2023.
BACKGROUND
In recent years, immune checkpoint inhibitors (ICIs) had extremely rapid growth in anti-cancer and improved outcomes of many malignancies, specifically lung cancer. However, the incidence of ICIs-related adverse events also raised. Using this meta-analysis, ICIs-related respiratory disorders were investigated in lung cancer patients.
METHODS
Using Cochrane Library, Embase, and PubMed databases, we performed an integrated search for randomized controlled trials (RCTs) to compare respiratory disorders among different regimens. The data was prepared with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, and the quality of included studies was evaluated based on the Cochrane manual.
RESULTS
In total, 22 RCTs were involved in this meta-analysis. Compared with ICIs, chemotherapy reduced the risk of interstitial lung disease (p = 0.03; SMD: 2.81; 95% CI: 1.08, 7.27), pleural effusion (p = 0.002; SMD: 2.12; 95% CI: 1.32, 3.42), and pneumonitis (p < 0.00001; SMD: 9.23; 95% CI: 4.57, 18.64). ICIs plus chemotherapy could provide a higher probability for patients to suffer pneumonitis than chemotherapy (p = 0.01; SMD: 1.96; 95% CI: 1.17, 3.28). In addition, single ICI brought a lower likelihood for patients suffering pneumonitis than double ICIs (p = 0.004; SMD: 2.17; 95% CI: 1.27, 3.69).
CONCLUSION
ICIs-based treatment, such as ICIs alone, ICIs plus chemotherapy and double ICIs, can raise the incidences of some respiratory disorders in patients with lung cancer. It suggests that ICIs should be conducted based on a comprehensive consideration to prevent ICIs-related respiratory disorders. To a certain degree, this study might be provided to the clinician as a reference for ICIs practice.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022378901, identifier (CRD42022378901).
背景
近年来，免疫检查点抑制剂（ICIs）在抗癌治疗中迅速发展，改善了多种恶性肿瘤的预后，尤其是肺癌。然而，ICIs 相关不良反应的发生率也有所上升。本研究通过荟萃分析，探讨了肺癌患者中与 ICI 相关的呼吸系统疾病。
方法
通过 Cochrane 图书馆、Embase 和 PubMed 数据库，对比较不同方案的随机对照试验（RCT）进行综合检索。采用系统评价和荟萃分析的首选报告项目（PRISMA）报告指南准备数据，并根据 Cochrane 手册评估纳入研究的质量。
结果
本荟萃分析共纳入 22 项 RCT。与 ICI 相比，化疗降低了间质性肺病（p = 0.03；SMD：2.81；95%CI：1.08，7.27）、胸腔积液（p = 0.002；SMD：2.12；95%CI：1.32，3.42）和肺炎（p < 0.00001；SMD：9.23；95%CI：4.57，18.64）的风险。ICI 联合化疗比化疗更有可能导致患者发生肺炎（p = 0.01；SMD：1.96；95%CI：1.17，3.28）。此外，与双 ICI 相比，单 ICI 使患者发生肺炎的可能性更低（p = 0.004；SMD：2.17；95%CI：1.27，3.69）。
结论
ICI 为基础的治疗，如单 ICI、ICI 联合化疗和双 ICI，可增加肺癌患者发生某些呼吸系统疾病的概率。这表明应综合考虑使用 ICI，以预防 ICI 相关的呼吸系统疾病。在某种程度上，本研究可为临床医生提供使用 ICI 的参考。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022378901，标识符（CRD42022378901）。
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