Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.
JAMA Dermatol. 2023 Oct 1;159(10):1093-1101. doi: 10.1001/jamadermatol.2023.3003.
Growing research suggests that the prevalence of cutaneous immune-related adverse events (cirAEs) is associated with favorable outcomes among individuals with cancer who receive immune checkpoint inhibitor (ICI) treatment.
To identify whether the presence of cirAEs and their subtypes subsequent to ICI administration is associated with enhanced cancer prognosis.
The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for publications examining the association between cirAE development during ICI treatment and subsequent cancer prognosis. The initial search was limited to English-language publications from database inception until December 31, 2022; a subsequent search was performed on May 21, 2023.
Two reviewers independently scrutinized the identical articles and included those that constituted original research evaluating the association between cirAE development and cancer prognosis.
The search terms, study objectives, and methodological protocols were defined before study initiation. The aforementioned 2 reviewers performed data extraction independently and resolved discrepancies through agreement. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis and the Meta-analysis of Observational Studies in Epidemiology reporting guidelines. The protocol was prospectively registered with PROSPERO. Data analyses were conducted between May 21 and June 1, 2023.
The major outcome end points were overall survival (OS) and progression-free survival (PFS). Subgroup analyses were also conducted according to cirAE type, cancer type, geographic region, study design, and ICI type. Given the heterogeneity inherent in the included studies, a DerSimonian-Laird random-effects model was adopted.
This systematic review and meta-analysis included 23 studies with a total of 22 749 patients treated with ICIs. The occurrence of cirAEs was associated with improved OS (hazard ratio [HR], 0.61 [95% CI, 0.52-0.72]; P < .001) and PFS (HR, 0.52 [95% CI, 0.41-0.65]; P < .001). Consistent results were observed across all subgroups stratified by study design, geographic region, ICI type, and cancer type, aligning with the overall estimate of OS and PFS improvement. However, no statistically significant differences were identified in terms of PFS within studies conducted in the US.
In this systematic review and meta-analysis, the presence of cirAEs and their subtypes was associated with improved prognosis for individuals with cancer undergoing ICI treatment. These findings suggest that cirAEs may have useful prognostic value in ICI treatment.
越来越多的研究表明，在接受免疫检查点抑制剂（ICI）治疗的癌症患者中，皮肤免疫相关不良事件（cirAEs）的发生率与良好的预后相关。
确定 ICI 治疗后 cirAEs 及其亚型的存在是否与增强的癌症预后相关。
在 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库中搜索了评估 cirAE 发展与癌症预后之间关联的出版物。最初的搜索仅限于自数据库成立到 2022 年 12 月 31 日的英文出版物；随后于 2023 年 5 月 21 日进行了第二次搜索。
两名审查员独立审查了相同的文章，并纳入了评估 cirAE 发展与癌症预后之间关联的原始研究。
在研究开始之前，定义了搜索词、研究目标和方法学方案。上述两名审查员独立进行了数据提取，并通过达成一致解决了差异。本研究遵循系统评价和荟萃分析的首选报告项目以及观察性研究荟萃分析的报告指南。该方案已在 PROSPERO 中进行了前瞻性注册。数据分析于 2023 年 5 月 21 日至 6 月 1 日进行。
主要终点是总生存期（OS）和无进展生存期（PFS）。还根据 cirAE 类型、癌症类型、地理区域、研究设计和 ICI 类型进行了亚组分析。由于纳入研究固有的异质性，采用了 DerSimonian-Laird 随机效应模型。
这项系统评价和荟萃分析包括 23 项研究，共有 22749 名接受 ICI 治疗的患者。cirAEs 的发生与 OS（风险比[HR]，0.61[95%CI，0.52-0.72]；P<0.001）和 PFS（HR，0.52[95%CI，0.41-0.65]；P<0.001）的改善相关。根据研究设计、地理区域、ICI 类型和癌症类型进行分层的所有亚组中均观察到一致的结果，与 OS 和 PFS 改善的总体估计值一致。然而，在美国进行的研究中，PFS 方面没有发现统计学上的显著差异。
在这项系统评价和荟萃分析中，cirAEs 的存在及其亚型与接受 ICI 治疗的癌症患者的预后改善相关。这些发现表明 cirAEs 在 ICI 治疗中可能具有有用的预后价值。
