PD-L1 在接受新辅助免疫检查点抑制剂联合化疗的非小细胞肺癌患者中的作用：一项荟萃分析。

The role of PD-L1 in patients with non-small cell lung cancer receiving neoadjuvant immune checkpoint inhibitor plus chemotherapy: a meta-analysis.

机构信息

Radiotherapy Department, The Third Affiliated Hospital of Guangxi Medical University, Dan-Cun Road No.13, Nanning, 530000, Guangxi, China.

出版信息

Sci Rep. 2024 Oct 31;14(1):26200. doi: 10.1038/s41598-024-78159-y.

BACKGROUND

The use of immune checkpoint inhibitors (ICIs) as neoadjuvant therapy is a promising novel approach in resectable non-small-cell lung cancer (NSCLC). This study aimed to investigate the prognostic value of PD-L1 in patients with NSCLC receiving neoadjuvant immune checkpoint inhibitor plus chemotherapy (CT).

MATERIALS AND METHODS

Several databases (PubMed, Embase, and cochrane central register of controlled trials [CENTRAL]) were systematically searched. Randomized controlled trials (RCTs) investigating pathological and survival outcomes with neoadjuvant ICI + CT versus CT alone in NSCLC were analyzed.

RESULTS

Overall, eight RCTs (n = 3,404) were included. The analyses showed neoadjuvant ICI + CT significantly improved complete pathological response (pCR) and event-free survival (EFS) in either tumor PD-L1 < 1%, ≥ 1%, 1-49%, or ≥ 50% population (both p < 0.0001) compared with neoadjuvant CT alone. The overall survival (OS) data are not yet mature among all included RCTs, and only three RCTs presented OS data by PD-L1 status of patients. The pooled OS favored neoadjuvant ICI + CT in the PD-L1 ≥ 1% population (hazard ratio [HR], 0.45; 95% CI, 0.31-0.65; p < 0.0001), but not in the PD-L1 < 1% population (HR, 0.89; 95% CI, 0.66-1.19; p = 0.43).

CONCLUSIONS

Compared with neoadjuvant CT alone, neoadjuvant ICI + CT significantly enhanced pCR and EFS for patients with resectable NSCLC regardless of the expression of PD-L1. It seems that only patients with PD-L1 positive tumors may achieve a better OS, but it's currently inconclusive due to immature data, so future research with long-term follow-up is still needed.

背景

免疫检查点抑制剂（ICIs）作为新辅助治疗在可切除非小细胞肺癌（NSCLC）中是一种很有前途的新方法。本研究旨在探讨 PD-L1 在接受新辅助免疫检查点抑制剂联合化疗（CT）的 NSCLC 患者中的预后价值。

材料和方法

系统检索了多个数据库（PubMed、Embase 和 Cochrane 对照试验中心注册库[CENTRAL]）。分析了新辅助 ICI+CT 与单独 CT 治疗 NSCLC 的病理和生存结果的随机对照试验（RCT）。

结果

共有 8 项 RCT（n=3404）纳入分析。结果表明，与单独新辅助 CT 相比，新辅助 ICI+CT 显著提高了肿瘤 PD-L1<1%、≥1%、1-49%或≥50%人群的完全病理缓解（pCR）和无事件生存（EFS）（均 p<0.0001）。所有纳入的 RCT 中总生存（OS）数据尚未成熟，只有 3 项 RCT 按患者的 PD-L1 状态提供了 OS 数据。荟萃分析结果表明，在 PD-L1≥1%的人群中，新辅助 ICI+CT 有利于 OS（风险比[HR]，0.45；95%CI，0.31-0.65；p<0.0001），但在 PD-L1<1%的人群中，新辅助 ICI+CT 并不有利于 OS（HR，0.89；95%CI，0.66-1.19；p=0.43）。