Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Front Immunol. 2023 Mar 23;14:1108213. doi: 10.3389/fimmu.2023.1108213. eCollection 2023.
The neoadjuvant use of immune checkpoint inhibitor combined with chemotherapy (nICT) or chemoradiotherapy (nICRT) in locally advanced esophageal cancer (EC) is currently an area of active ongoing research. Therefore, we carried out a comprehensive meta-analysis to compare the efficacy and safety of the new strategy with routine neoadjuvant strategy, which included neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT).
MEDLINE (via PubMed), Embase (via OVID), ISI Web of Science database and Cochrane Library were included. And, all of them were searched for eligible studies between January, 2000 and February, 2023. The pathological complete response (pCR) and major pathological response (MPR) were primary outcome of our study. The second outcome of interest was R0 resection rate. Odds ratio (OR) and associated 95% CI were used as the effect indicators comparing the safety and efficiency of the neoadjuvant immunotherapy with the routine neoadjuvant therapy. Fixed-effect model (Inverse Variance) or random-effect model (Mantel-Haenszel method) was performed depending on the statistically heterogeneity.
There were eight trials with 652 patients were included in our meta-analysis. The estimated pCR rate was higher in the neoadjuvant immunotherapy group (OR =1.86; 95% CI, 1.25-2.75; I = 32.8%, =0.166). The different results were found in the esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) subgroups, the estimated OR was 2.35 (95%CI, 1.00-2.72; I = 30.9%, =0.215) in the EAC subgroup, and 2.35 (95% CI, 1.20-4.54; I = 45.3%, =0.161) in the ESCC subgroup, respectively. The neoadjuvant immunotherapy also showed the advantage in the MPR rates (OR =2.66; 95% CI, 1.69-4.19; I = 24.3%, =0.252). There was no obvious difference between the neoadjuvant immunotherapy and routine neoadjuvant therapy with respect to surgical resection rate, R0 resection rate, surgical delay rate; while more treatment-related adverse events were observed for the neoadjuvant immunotherapy for pneumonitis/pneumonia (OR=3.46, 95% CI, 1.31-9.16; I = 67.3%, =0.005) and thyroid dysfunction (OR=4.69, 95% CI, 1.53-14.36; I = 56.5%, =0.032).
The pooled correlations indicated that the neoadjuvant immunotherapy (both nICT and nICRT) could significantly increase the rates of pCR and MPR, compared with routine neoadjuvant therapy (both nCT and nCRT) in the treatment of locally advanced EC. The neoadjuvant immunotherapy and routine neoadjuvant therapy were with acceptable toxicity. However, randomized studies with larger groups of patients need to performed to confirm these results.
https://www.crd.york.ac.uk/prospero/, identifier CRD42020155802.
局部晚期食管癌（EC）新辅助免疫检查点抑制剂联合化疗（nICT）或放化疗（nICRT）的应用目前是一个活跃的研究领域。因此，我们进行了一项全面的荟萃分析，比较了新策略与常规新辅助策略（包括新辅助化疗（nCT）和新辅助放化疗（nCRT））的疗效和安全性。
检索了 2000 年 1 月至 2023 年 2 月期间 MEDLINE（通过 PubMed）、Embase（通过 OVID）、ISI Web of Science 数据库和 Cochrane Library 中的相关文献。主要研究结果是病理完全缓解（pCR）和主要病理缓解（MPR）。次要研究结果为 R0 切除率。使用比值比（OR）和相关 95%置信区间（CI）作为比较新辅助免疫治疗与常规新辅助治疗安全性和效率的效应指标。根据统计学异质性，采用固定效应模型（Inverse Variance）或随机效应模型（Mantel-Haenszel 方法）。
荟萃分析纳入了 8 项共 652 例患者的试验。新辅助免疫治疗组的 pCR 率更高（OR=1.86；95%CI，1.25-2.75；I=32.8%，=0.166）。在食管鳞状细胞癌（ESCC）和食管腺癌（EAC）亚组中观察到不同的结果，EAC 亚组的估计 OR 为 2.35（95%CI，1.00-2.72；I=30.9%，=0.215），ESCC 亚组为 2.35（95%CI，1.20-4.54；I=45.3%，=0.161）。新辅助免疫治疗在 MPR 率方面也具有优势（OR=2.66；95%CI，1.69-4.19；I=24.3%，=0.252）。新辅助免疫治疗与常规新辅助治疗在手术切除率、R0 切除率和手术延迟率方面无明显差异；然而，新辅助免疫治疗与更多的治疗相关不良事件相关，包括肺炎/肺炎（OR=3.46，95%CI，1.31-9.16；I=67.3%，=0.005）和甲状腺功能障碍（OR=4.69，95%CI，1.53-14.36；I=56.5%，=0.032）。
荟萃分析的相关性表明，与常规新辅助治疗（nCT 和 nCRT）相比，新辅助免疫治疗（nICT 和 nICRT）可显著提高局部晚期 EC 的 pCR 和 MPR 率。新辅助免疫治疗和常规新辅助治疗的毒性可接受。然而，需要进行更大规模的患者群体的随机研究来证实这些结果。
https://www.crd.york.ac.uk/prospero/，标识符 CRD42020155802。
Zotero 插件
