可切除胃/胃食管交界肿瘤新辅助免疫治疗的评价：荟萃分析和系统评价。

Evaluation of neoadjuvant immunotherapy in resectable gastric/gastroesophageal junction tumors: a meta-analysis and systematic review.

机构信息

Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, China.

出版信息

Front Immunol. 2024 Jan 30;15:1339757. doi: 10.3389/fimmu.2024.1339757. eCollection 2024.

BACKGROUND

Neoadjuvant therapy for resectable gastric cancer/gastroesophageal junction tumors is progressing slowly. Although immunotherapy for advanced gastric cancer/gastroesophageal junction tumors has made great progress, the efficacy and safety of neoadjuvant immunotherapy for locally resectable gastric cancer/gastroesophageal junction tumors have not been clearly demonstrated. Here, we conducted a systematic review and meta-analysis to assess the efficacy and safety of neoadjuvant immunotherapy and advance the current research.

METHODS

Original articles describing the safety and efficacy of neoadjuvant immunotherapy for resectable gastric cancer/gastroesophageal junction tumors published up until October 15, 2023 were retrieved from PubMed, Embase, the Cochrane Library, and other major databases. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated for heterogeneity and subgroup analysis.

RESULTS

A total of 1074 patients from 33 studies were included. The effectiveness of neoadjuvant immunotherapy was mainly evaluated using pathological complete remission (PCR), major pathological remission (MPR), and tumor regression grade (TRG). Among the included patients, 1015 underwent surgical treatment and 847 achieved R0 resection. Of the patients treated with neoadjuvant immunotherapy, 24% (95% CI: 19%-28%) achieved PCR and 49% (95% CI: 38%-61%) achieved MPR. Safety was assessed by a surgical resection rate of 0.89 (95% CI: 85%-93%), incidence of ≥ 3 treatment-related adverse events (TRAEs) of 28% (95% CI: 17%-40%), and incidence of ≥ 3 immune-related adverse events (irAEs) of 19% (95% CI: 11%-27%).

CONCLUSION

Neoadjuvant immunotherapy, especially neoadjuvant dual-immunotherapy combinations, is effective and safe for resectable gastric/gastroesophageal junction tumors in the short term. Nevertheless, further multicenter randomized trials are required to demonstrate which combination model is more beneficial.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=358752, identifier CRD42022358752.

背景

可切除的胃癌/胃食管交界肿瘤的新辅助治疗进展缓慢。尽管晚期胃癌/胃食管交界肿瘤的免疫治疗已取得重大进展，但局部可切除的胃癌/胃食管交界肿瘤的新辅助免疫治疗的疗效和安全性尚未得到明确证实。在这里，我们进行了一项系统评价和荟萃分析，以评估新辅助免疫治疗的疗效和安全性，并推进当前的研究。

方法

从 PubMed、Embase、Cochrane 图书馆和其他主要数据库中检索截至 2023 年 10 月 15 日发表的描述可切除胃癌/胃食管交界肿瘤新辅助免疫治疗安全性和疗效的原始文章。使用优势比（OR）和 95%置信区间（CI）进行异质性和亚组分析。

结果

共纳入来自 33 项研究的 1074 名患者。新辅助免疫治疗的有效性主要通过病理完全缓解（PCR）、主要病理缓解（MPR）和肿瘤消退分级（TRG）来评估。在纳入的患者中，1015 名患者接受了手术治疗，847 名患者达到了 R0 切除。接受新辅助免疫治疗的患者中，24%（95%CI：19%-28%）达到 PCR，49%（95%CI：38%-61%）达到 MPR。通过 0.89（95%CI：85%-93%）的手术切除率、28%（95%CI：17%-40%）的≥3 级治疗相关不良事件发生率和 19%（95%CI：11%-27%）的≥3 级免疫相关不良事件发生率来评估安全性。