Clinical Medical College of Jining Medical University, Jining, Shandong Province, China.
Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Cancer Med. 2024 May;13(9):e7176. doi: 10.1002/cam4.7176.
In recent years, neoadjuvant immunotherapy (NAIT) has developed rapidly in patients with gastroesophageal junction cancer (GEJC). The suggested neoadjuvant treatment regimens for patients with GEJC may vary in light of the efficacy and safety results.
A search of the Cochrane Library, PubMed, Embase, and Web of Science was completed to locate studies examining the safety and effectiveness of NAIT for resectable GEJC. We analyzed the effect sizes (ES) and 95% confidence intervals (CI) in addition to subgroups and heterogeneity. Meta-analyses were performed using Stata BE17 software.
For these meta-analyses, 753 patients were chosen from 21 studies. The effectiveness of NAIT was assessed using the pathological complete response (pCR), major pathological response (MPR), and nodal downstage to ypN0 rate. The MPR, pCR, and nodal downstage to ypN0 rate values in NAIT were noticeably higher (MPR: ES = 0.45; 95% CI: 0.36-0.54; pCR: ES = 0.26; 95% CI: 0.21-0.32; nodal downstage to ypN0 rate: ES = 0.60; 95% CI: 0.48-0.72) than those of neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) (MPR < 30%; pCR: ES = 3%-17%; nodal downstage to ypN0 rate: ES = 21%-29%). Safety was assessed using the treatment-related adverse events (trAEs) incidence rate, surgical delay rate, surgical complications incidence rate, and surgical resection rate. In conclusion, the incidence of trAEs, incidence of surgical complications, and surgical delay rate had ES values of 0.66, 0.48, and 0.09, respectively. These rates were comparable to those from nCT or nCRT (95% CI: 0.60-0.70; 0.15-0.51; and 0, respectively). The reported resection rates of 85%-95% with nCT or nCRT were comparable to the mean surgical resection rate of 90%.
NAIT is an effective treatment for resectable GEJC; additionally, the level of NAIT toxicity is acceptable. The long-term effects of NAIT require further study.
近年来，胃食管结合部癌（GEJC）患者的新辅助免疫治疗（NAIT）发展迅速。根据疗效和安全性结果，建议的 GEJC 患者新辅助治疗方案可能有所不同。
对 Cochrane 图书馆、PubMed、Embase 和 Web of Science 进行了检索，以查找评估可切除 GEJC 患者 NAIT 安全性和有效性的研究。我们分析了效应大小（ES）和 95%置信区间（CI），以及亚组和异质性。使用 Stata BE17 软件进行了荟萃分析。
这些荟萃分析共纳入了 21 项研究中的 753 名患者。NAIT 的有效性通过病理完全缓解（pCR）、主要病理缓解（MPR）和淋巴结降期至ypN0 率来评估。NAIT 的 MPR、pCR 和淋巴结降期至 ypN0 率值明显更高（MPR：ES=0.45；95%CI：0.36-0.54；pCR：ES=0.26；95%CI：0.21-0.32；淋巴结降期至 ypN0 率：ES=0.60；95%CI：0.48-0.72），而新辅助化疗（nCT）或新辅助放化疗（nCRT）的则较低（MPR<30%；pCR：ES=3%-17%；淋巴结降期至 ypN0 率：ES=21%-29%）。安全性通过治疗相关不良事件（trAEs）发生率、手术延迟率、手术并发症发生率和手术切除率来评估。总之，trAEs、手术并发症和手术延迟的发生率的 ES 值分别为 0.66、0.48 和 0.09。这些比率与 nCT 或 nCRT 相似（95%CI：0.60-0.70；0.15-0.51；0）。nCT 或 nCRT 报道的 85%-95%的切除率与 90%的平均手术切除率相当。
NAIT 是一种治疗可切除 GEJC 的有效方法，其毒性水平可以接受。NAIT 的长期效果需要进一步研究。
