Ma Shixin, Nie He, Wei Chaoyu, Jin Cailong, Wang Lunqing
Graduate School, Dalian Medical University, Dalian, Liaoning, China.
Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China.
Front Oncol. 2024 May 8;14:1402017. doi: 10.3389/fonc.2024.1402017. eCollection 2024.
The emergence of immune checkpoint inhibitors (ICIs) provides a variety of options for patients with advanced non-small-cell lung cancer (NSCLC). After the application of ICIs, the immune system of patients was highly activated, and immune-related adverse events (irAEs) could occur in some organ systems, and irAEs seemed to be associated with the survival prognosis of patients. Therefore, we evaluated the association between survival outcomes and irAEs in NSCLC patients and conducted a systematic review and meta-analysis.
We conducted systematic reviews of PubMed, Embase, Cochrane, and Web of Science databases until December 2021. The forest map was constructed by combining the hazard ratio (HR) and 95% confidence interval (CI). I estimated the heterogeneity between studies. A meta-analysis was performed using R 4.2.1 software.
Eighteen studies included 4808 patients with advanced NSCLC. In pooled analysis, the occurrence of irAEs was found to be a favorable factor for improved prognosis (PFS: HR: 0.48, 95% CI: 0.41-0.55, P <0.01; OS: HR: 0.46, 95% CI: 0.42-0.52, P <0.01). In subgroup analyses, cutaneous irAE, gastrointestinal irAE, endocrine irAE and grade ≥3 irAEs were associated with improvements in PFS and OS, but pulmonary and hepatic irAEs were not.
Existing evidence suggests that the occurrence of irAEs may be a prognostic biomarker for advanced NSCLC. However, further research is needed to explore the prospect of irAEs as a prognostic biomarker in patients undergoing immunotherapy.
https://www.crd.york.ac.uk/PROSPEROFILES/405333_STRATEGY_20240502.pdf, identifier CRD42023405333.
免疫检查点抑制剂（ICI）的出现为晚期非小细胞肺癌（NSCLC）患者提供了多种选择。ICI应用后，患者的免疫系统被高度激活，一些器官系统可能会发生免疫相关不良事件（irAE），且irAE似乎与患者的生存预后相关。因此，我们评估了NSCLC患者生存结局与irAE之间的关联，并进行了系统评价和荟萃分析。
我们对PubMed、Embase、Cochrane和Web of Science数据库进行了系统评价，直至2021年12月。通过合并风险比（HR）和95%置信区间（CI）构建森林图。我估计了研究之间的异质性。使用R 4.2.1软件进行荟萃分析。
18项研究纳入了4808例晚期NSCLC患者。在汇总分析中，发现irAE的发生是预后改善的有利因素（无进展生存期：HR：0.48，95%CI：0.41-0.55，P<0.01；总生存期：HR：0.46，95%CI：0.42-0.52，P<0.01）。在亚组分析中，皮肤irAE、胃肠道irAE、内分泌irAE和≥3级irAE与无进展生存期和总生存期的改善相关，但肺部和肝脏irAE则不然。
现有证据表明，irAE的发生可能是晚期NSCLC的预后生物标志物。然而，需要进一步研究以探索irAE作为免疫治疗患者预后生物标志物的前景。
https://www.crd.york.ac.uk/PROSPEROFILES/405333_STRATEGY_20240502.pdf，标识符CRD42023405333。
