de Moraes Francisco Cezar Aquino, Sano Vitor Kendi Tsuchiya, Silva Barbara Lins, Silva Ana Laura Soares, Castro Stellanny Cilene Rodrigues, Kreuz Michele, Fernandes Lilianne Rodrigues, Kelly Francinny Alves, Burbano Rommel Mario Rodríguez
Federal University of Pará, R. Augusto Corrêa, GuamáBelem, Pará, nº0166073-005, Brazil.
Federal University of Acre, Rio Branco, Acre, 69920-900, Brazil.
J Gastrointest Cancer. 2025 Jan 20;56(1):49. doi: 10.1007/s12029-024-01141-4.
Gastric cancer (GC) remains a leading cause of morbidity and mortality worldwide. The current standard of care involves neoadjuvant chemotherapy (NACT) followed by radical gastrectomy. This study aims to evaluate the efficacy of neoadjuvant therapy with PD-1/PD-L1 inhibitors in comparison to chemotherapy alone for patients with locally advanced gastric cancer (LAGC).
We conducted a systematic search of PubMed, Web of Science, and Embase to identify studies examining the addition of PD-1/PD-L1 inhibitors to neoadjuvant therapy for LAGC. Odds ratios (OR) were calculated for binary outcomes, such as pathological complete response (pCR), with corresponding 95% confidence intervals (CI).
Seven studies were included, encompassing a total of 1772 patients. Baseline median age ranged from 31 to 75 years. Most patients had an ECOG performance status score of 0 (942 patients), while 294 had an ECOG score of 1. The estimated pCR (OR 5.94, 95% CI 3.98-8.87; p < 0.000001) significantly favored the PD-1/PD-L1 inhibitors combined with chemotherapy over chemotherapy alone. Additionally, the incidence of certain adverse events increased significantly in the intervention group, including any-grade hypothyroidism (OR 4.55, 95% CI 2.27-9.10; p = 0.000019) and rash (OR 1.74, 95% CI 1.10-2.76; p = 0.017). Conversely, the control group showed a statistically significant lower incidence of grade ≥ 3 fatigue (OR 2.80, 95% CI 1.15-6.85; p = 0.024) compared to the intervention group.
This systematic review and meta-analysis indicate that the addition of PD-1/PD-L1 inhibitors to neoadjuvant chemotherapy is associated with a higher pathological complete response rate compared to chemotherapy alone in patients with locally advanced gastric cancer.
胃癌（GC）仍是全球发病和死亡的主要原因。当前的标准治疗方案包括新辅助化疗（NACT），随后进行根治性胃切除术。本研究旨在评估与单纯化疗相比，PD-1/PD-L1抑制剂新辅助治疗对局部晚期胃癌（LAGC）患者的疗效。
我们对PubMed、科学网和Embase进行了系统检索，以确定研究在LAGC新辅助治疗中添加PD-1/PD-L1抑制剂的研究。计算二分类结局（如病理完全缓解（pCR））的比值比（OR）及相应的95%置信区间（CI）。
纳入7项研究，共1772例患者。基线年龄中位数为31至75岁。大多数患者的东部肿瘤协作组（ECOG）体能状态评分为0（942例患者），而294例评分为1。估计的pCR（OR 5.94，95%CI 3.98 - 8.87；p < 0.000001）显著支持PD-1/PD-L1抑制剂联合化疗优于单纯化疗。此外，干预组某些不良事件的发生率显著增加，包括任何级别的甲状腺功能减退（OR 4.55，95%CI 2.27 - 9.10；p = 0.000019）和皮疹（OR 1.74，95%CI 1.10 - 2.76；p = 0.017）。相反，与干预组相比，对照组≥3级疲劳的发生率在统计学上显著更低（OR 2.80，95%CI 1.15 - 6.85；p = 0.024）。
本系统评价和荟萃分析表明，在局部晚期胃癌患者中，与单纯化疗相比，新辅助化疗中添加PD-1/PD-L1抑制剂与更高的病理完全缓解率相关。
