Bedin Ana Paula, de Castro Neves Carmo Maffezolli Gabriela, Rego Luis Henrique Rios Moreira, Carlos Maria Isadora Rodrigues, da Silva Pedro Henrique Albuquerque, de Moraes Francisco Cezar Aquino
Municipal University of São Caetano do Sul, São Paulo, 01327-000, Brazil.
Faculty of Medical Sciences of Santos, Santos, 11015-101, Brazil.
Clin Transl Oncol. 2025 Aug 8. doi: 10.1007/s12094-025-04027-4.
BACKGROUND: Non-small cell lung cancer (NSCLC) is prevalent and often diagnosed at advanced stages. Immune checkpoint inhibitors targeting PD-1/PD-L1 pathways have transformed treatment, yet elderly patients remain underrepresented in clinical trials. METHODS: We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing PD-1/PD-L1 inhibitors with placebo and/or chemotherapy in elderly patients with NSCLC. Overall survival (OS), Event-Free Survival (EFS) and OS for large studies were evaluated. Random-effects model with 95% confidence intervals were applied. RESULTS: Twelve RCTs with 3078 patients were included. PD-1/PD-L1 inhibitors significantly improved OS (HR 0.76; 95% CI 0.69-0.84; p < 0.001) and EFS (HR 0.67; 95% CI 0.54-0.83; p < 0.001). Large studies showed consistent benefit. CONCLUSIONS: PD-1/PD-L1 inhibitors significantly improve clinical outcomes in elderly NSCLC patients compared to standard treatments.
背景：非小细胞肺癌（NSCLC）很常见，且往往在晚期才被诊断出来。靶向PD-1/PD-L1通路的免疫检查点抑制剂改变了治疗方式，但老年患者在临床试验中的代表性仍然不足。 方法：我们对比较PD-1/PD-L1抑制剂与安慰剂和/或化疗在老年NSCLC患者中的随机临床试验（RCT）进行了系统评价和荟萃分析。评估了总生存期（OS）、无事件生存期（EFS）以及大型研究中的OS。应用了具有95%置信区间的随机效应模型。 结果：纳入了12项RCT，共3078例患者。PD-1/PD-L1抑制剂显著改善了OS（风险比0.76；95%置信区间0.69-0.84；p＜0.001）和EFS（风险比0.67；95%置信区间0.54-0.83；p＜0.001）。大型研究显示出一致的获益。 结论：与标准治疗相比，PD-1/PD-L1抑制剂显著改善了老年NSCLC患者的临床结局。
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