吸烟状态对肺癌免疫治疗的影响：一项系统评价和荟萃分析。

Effect of smoking status on immunotherapy for lung cancer: a systematic review and meta-analysis.

作者信息

Luo Dachen, Yang Dongmei, Cao Dan, Gong Zonglian, He Fang, Hou Yaqin, Lin Shan

机构信息

Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.

Department of Pharmacy, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.

出版信息

Front Oncol. 2024 Oct 8;14:1422160. doi: 10.3389/fonc.2024.1422160. eCollection 2024.

BACKGROUND

Recent studies have yielded conflicting results regarding the relationship between smoking history and the effectiveness of immune checkpoint inhibitors (ICIs) for advanced lung cancer. While some studies have suggested that smoking may enhance the response to immunotherapy in patients with lung cancer, other findings indicate the contrary. Therefore, we conducted a systematic review and meta-analysis to thoroughly examine this association.

METHODS

We searched the PubMed, Embase, and Scopus databases for clinical trials comparing immunotherapy with conventional chemotherapy as the primary treatment for advanced lung cancer. A random effects model was used to synthesize hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS). We also conducted predefined subgroup analyses to investigate the efficacy disparities between never-smokers and smokers who were administered immunotherapy alone or in combination with chemotherapy, as well as the differences between former and current smokers under similar treatment modalities.

RESULTS

Our analysis included data from 17 Phase III clinical trials involving 10,283 patients. The findings indicate that immunotherapy benefits both smokers and never-smokers with lung cancer or non-small cell lung cancer, yielding pooled HRs for OS of 0.74 (95% CI: 0.59-0.92) and 0.73 (95% CI: 0.67-0.80), respectively. A significant interaction effect was not observed (HR: 0.98, 95% CI: 0.77-1.24, p = 0.14), and the tumor type, immunotherapy combination, and type of immunotherapy did not differ among the groups in the subgroup analyses. Similarly, both former and current smokers experienced a significant survival benefit from immunotherapy, with pooled HRs for OS of 0.79 (95% CI: 0.68-0.91) and 0.71 (95% CI: 0.59-0.87), respectively. However, a significant interaction effect was also not observed (HR: 0.91, 95% CI: 0.74-1.11, p = 0.14).

CONCLUSION

Our findings suggest that smoking status does not affect the effectiveness of immunotherapy for lung cancer treatment. However, additional high-quality clinical trials are needed to confirm this conclusion.

SYSTEMATIC REVIEW REGISTRATION

https://inplasy.com/register/, identifier INPLASY2023110058.

背景

近期研究在吸烟史与免疫检查点抑制剂（ICI）对晚期肺癌疗效之间的关系上得出了相互矛盾的结果。虽然一些研究表明吸烟可能增强肺癌患者对免疫治疗的反应，但其他研究结果则相反。因此，我们进行了一项系统评价和荟萃分析，以全面研究这种关联。

方法

我们在PubMed、Embase和Scopus数据库中检索了将免疫治疗与传统化疗作为晚期肺癌主要治疗方法进行比较的临床试验。采用随机效应模型来综合总生存期（OS）的风险比（HR）和95%置信区间（CI）。我们还进行了预定义的亚组分析，以研究单独接受免疫治疗或联合化疗的从不吸烟者与吸烟者之间的疗效差异，以及在类似治疗方式下既往吸烟者与当前吸烟者之间的差异。

结果

我们的分析纳入了17项III期临床试验的数据，涉及10283例患者。研究结果表明，免疫治疗对肺癌或非小细胞肺癌的吸烟者和从不吸烟者均有益，OS的合并HR分别为0.74（95%CI：0.59 - 0.92）和0.73（95%CI：0.67 - 0.80）。未观察到显著的交互作用（HR：0.98，95%CI：0.77 - 1.24，p = 0.14），亚组分析中各亚组间的肿瘤类型、免疫治疗联合方案和免疫治疗类型无差异。同样，既往吸烟者和当前吸烟者均从免疫治疗中获得了显著的生存益处，OS的合并HR分别为0.79（95%CI：0.68 - 0.91）和0.71（95%CI：0.59 - 0.87）。然而，也未观察到显著的交互作用（HR：0.91，95%CI：0.74 - 1.11，p = 0.14）。