肝转移对癌症患者免疫检查点抑制剂疗效的影响:系统评价和荟萃分析。
Effect of liver metastasis on the efficacy of immune checkpoint inhibitors in cancer patients: a systemic review and meta-analysis.
机构信息
Department of general surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China.
Institute for Financial Studies, Shandong Univeristy, Jinan, 250100, People's Republic of China.
出版信息
Clin Exp Metastasis. 2023 Aug;40(4):255-287. doi: 10.1007/s10585-023-10217-7. Epub 2023 Jun 13.
Liver metastasis is a frequent phenomenon in advanced tumor disease. Immune checkpoint inhibitors (ICIs) are a new class of therapeutics that can improve the prognosis of cancer patients. The purpose of this study is to elucidate the relationship between liver metastasis and survival outcomes of patients receiving ICIs treatment. We searched four main databases, including PubMed, EMBASE, Cochrane Library, and Web of Science. Overall survival (OS) and progression-free survival (PFS) were the survival outcomes of our concern. Hazard ratio (HR) with 95% confidence interval (CI) were used to evaluate the relationship between liver metastasis and OS/ PFS. Finally, 163 articles were included in the study. The pooled results showed that patients with liver metastasis receiving ICIs treatment had worse OS (HR=1.82, 95%CI:1.59-2.08) and PFS (HR=1.68, 95%CI:1.49-1.89) than patients without liver metastasis. The effect of liver metastasis on ICIs efficacy differed in different tumor types, and patients with urinary system tumors (renal cell carcinoma OS: HR=2.47, 95%CI:1.76-3.45; urothelial carcinoma OS: HR=2.37, 95%CI:2.03-2.76) had the worst prognosis, followed by patients with melanoma (OS: HR=2.04, 95%CI:1.68-2.49) or non-small cell lung cancer (OS: HR=1.81, 95%CI:1.72-1.91). ICIs efficacy in digestive system tumors (colorectal cancer OS: HR=1.35, 95%CI:1.07-1.71; gastric cancer/ esophagogastric cancer OS: HR=1.17, 95%CI:0.90-1.52) was less affected, and peritoneal metastasis and the number of metastases have a greater clinical significance than liver metastasis based on univariate data. For cancer patients receiving ICIs treatment, the occurrence of liver metastasis is associated with poor prognosis. Different cancer types and metastatic sites may hold a different prognostic effect on the efficacy of ICIs treatment in cancer patients.
肝转移是晚期肿瘤疾病中常见的现象。免疫检查点抑制剂(ICIs)是一类新的治疗药物,可以改善癌症患者的预后。本研究旨在阐明肝转移与接受 ICI 治疗的患者生存结局之间的关系。我们检索了四个主要数据库,包括 PubMed、EMBASE、Cochrane 图书馆和 Web of Science。总生存期(OS)和无进展生存期(PFS)是我们关注的生存结局。风险比(HR)及其 95%置信区间(CI)用于评估肝转移与 OS/PFS 之间的关系。最终,有 163 篇文章纳入研究。汇总结果显示,接受 ICI 治疗的肝转移患者的 OS(HR=1.82,95%CI:1.59-2.08)和 PFS(HR=1.68,95%CI:1.49-1.89)均较无肝转移患者差。肝转移对 ICI 疗效的影响在不同肿瘤类型中存在差异,泌尿系统肿瘤(肾细胞癌 OS:HR=2.47,95%CI:1.76-3.45;尿路上皮癌 OS:HR=2.37,95%CI:2.03-2.76)患者预后最差,其次是黑色素瘤(OS:HR=2.04,95%CI:1.68-2.49)或非小细胞肺癌(OS:HR=1.81,95%CI:1.72-1.91)患者。消化系统肿瘤(结直肠癌 OS:HR=1.35,95%CI:1.07-1.71;胃癌/胃食管交界处癌 OS:HR=1.17,95%CI:0.90-1.52)患者受影响较小,且基于单变量数据,腹膜转移和转移灶数量比肝转移具有更大的临床意义。对于接受 ICI 治疗的癌症患者,肝转移的发生与预后不良相关。不同的癌症类型和转移部位可能对癌症患者 ICI 治疗的疗效具有不同的预后影响。