Zhang Qi-Jing, Zhou Jia-Xin, Hu Da-Hai, Pan Jing-Hua, Luo Si-Min, Yao Qi
Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
School of Medicine, Jinan University, Guangzhou, Guangdong, China.
Front Oncol. 2025 Jun 12;15:1514485. doi: 10.3389/fonc.2025.1514485. eCollection 2025.
Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, necessitating innovative therapeutic approaches. Most patients with CRC exhibit microsatellite instability-low/stable (MSI-L/MSS) or proficient mismatch repair (pMMR) status, with chemotherapy being the standard first-line treatment. Chemoimmunotherapy, incorporating immune checkpoint inhibitors (ICIs), has emerged as a potential treatment for MSI-L/MSS/pMMR CRC. This study aimed to comprehensively evaluate the efficacy and safety of chemoimmunotherapy in metastatic CRC (mCRC) patients with MSI-L/MSS/pMMR status.
A systematic search of PubMed, EMBASE, ScienceDirect, and Cochrane Library was conducted in accordance with PRISMA guidelines, targeting studies published between May 2022 and September 2024. The meta-analyses utilized the generic inverse-variance method with a random effects model.
Four studies encompassing 934 patients with mCRC met the inclusion criteria. The meta-analysis revealed a significant reduction in the risk of progression or death with chemoimmunotherapy compared with chemotherapy (HR: 0.82, 95% CI: 0.70-0.97, = 0.02). Subgroup analyses based on sex (male vs. female) and ECOG status consistently demonstrated a significant benefit of chemoimmunotherapy in MSI-L/MSS/pMMR tumors. Adverse event analysis indicated an increase in adverse events in the chemoimmunotherapy group.
Existing evidence indicates a statistically significant and clinically meaningful benefit in PFS with chemoimmunotherapy, albeit with a slight increase in all-grade and high-grade toxicities compared to chemotherapy. Future research focusing on biomarkers and innovative treatments is essential for enhancing patient outcomes.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024520150.
结直肠癌（CRC）仍是全球癌症相关死亡的主要原因，因此需要创新的治疗方法。大多数CRC患者表现为微卫星不稳定性低/稳定（MSI-L/MSS）或错配修复功能正常（pMMR）状态，化疗是标准的一线治疗方法。包含免疫检查点抑制剂（ICI）的化疗免疫疗法已成为MSI-L/MSS/pMMR CRC的一种潜在治疗方法。本研究旨在全面评估化疗免疫疗法在MSI-L/MSS/pMMR状态的转移性结直肠癌（mCRC）患者中的疗效和安全性。
根据PRISMA指南，对PubMed、EMBASE、ScienceDirect和Cochrane图书馆进行系统检索，检索2022年5月至2024年9月发表的研究。荟萃分析采用通用逆方差法和随机效应模型。
四项纳入934例mCRC患者的研究符合纳入标准。荟萃分析显示，与化疗相比，化疗免疫疗法可显著降低疾病进展或死亡风险（HR：0.82，95%CI：0.70-0.97，P = 0.02）。基于性别（男性与女性）和东部肿瘤协作组（ECOG）状态的亚组分析一致表明，化疗免疫疗法对MSI-L/MSS/pMMR肿瘤具有显著益处。不良事件分析表明，化疗免疫疗法组的不良事件有所增加。
现有证据表明，化疗免疫疗法在无进展生存期方面具有统计学显著且临床有意义的益处，尽管与化疗相比，所有级别和高级别毒性略有增加。未来聚焦于生物标志物和创新治疗的研究对于改善患者预后至关重要。
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