新辅助免疫疗法加化疗治疗可切除非小细胞肺癌的疗效和安全性Meta分析。

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal Pub Date : 2024-10-02 DOI:10.1111/crj.70019

Xinru Sun, Tianhua Kang, Baodong Liu, Yin Zhang, Guangming Huang

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引用次数: 0

摘要

简介新辅助免疫治疗加化疗为NSCLC患者的外科治疗开创了新纪元。本研究旨在探讨新辅助免疫疗法加化疗治疗 NSCLC 的有效性和安全性：从 PubMed、Embase、Web of Science、Cochrane Library、ClinicalTrials.gov 和会议摘要中筛选出符合条件的研究。研究终点包括主要病理反应（MPR）、完全病理反应（pCR）、手术切除率、R0切除率、治疗相关不良事件（TRAE）、严重不良事件（SAE）、手术并发症、治疗中断、手术延迟以及治疗相关死亡。统计分析使用Stata 18软件，P 结果：在接受新辅助免疫疗法加化疗的患者中，总的MPR率为51%（95% CI [0.44-0.58]），pCR率为34%（95% CI [0.28-0.40]）。汇总的手术切除率为85%（95% CI [0.81-0.89]），汇总的R0率为94%（95% CI [0.91-0.96]）。肿瘤病理降期的汇总率为84%（95% CI [0.79-0.88]），结节病理降期的汇总率为38%（95% CI [0.23-0.57]）。在新辅助免疫疗法加化疗加或不加手术的治疗过程中，TRAEs（任何级别）的汇总率为84%（95% CI [0.73-0.91]），SAEs的汇总率为29%（95% CI [0.21-0.38]）。手术并发症的总发生率为 25%（95% CI [0.14-0.41]）。治疗中断（11%，95% CI [0.09-0.13]）、手术延迟（3%，95% CI [0.02-0.05]）和治疗相关死亡（2%，95% CI [0.02-0.03]）的汇总率均为：结论：新辅助免疫治疗加化疗可获得较高的病理反应、手术切除率、R0切除率和病理降期率，且增加SAE、手术并发症、治疗中止、手术延迟和治疗相关死亡的风险较低。这一结论需要前瞻性大样本研究的验证。

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A Meta-Analysis of Efficacy and Safety of Neoadjuvant Immunotherapy Plus Chemotherapy for Resectable Non-Small Cell Lung Cancer

Introduction

Neoadjuvant immunotherapy plus chemotherapy has ushered in a new era for surgical treatment for patients with NSCLC. This study aimed to examine the efficacy and safety of neoadjuvant immunotherapy plus chemotherapy in NSCLC.

Methods

Eligible studies were identified from PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, and conference meeting abstracts. The endpoints included major pathological response (MPR), complete pathological response (pCR), surgical resection rate, R0 resection, treatment-related adverse events (TRAEs), severe adverse events (SAEs), surgical complications, treatment discontinuation, surgical delay, and treatment-related death. Stata 18 software was used for statistical analysis, and p < 0.05 was considered statistically significant. Twenty-two studies including a total of 1108 patients were eligible for this study.

Results

Among the patients who received neoadjuvant immunotherapy plus chemotherapy, the pooled MPR rate was 51% (95% CI [0.44–0.58]), and pCR rate was 34% (95% CI [0.28–0.40]). The pooled surgical resection rate was 85% (95% CI [0.81–0.89]), and the pooled R0 rate was 94% (95% CI [0.91–0.96]). The pooled rate of pathological tumor downstaging was 84% (95% CI [0.79–0.88]), and the pooled rate of pathological nodal downstaging was 38% (95% CI [0.23–0.57]). During the treatment of neoadjuvant immunotherapy plus chemotherapy with or without surgery, the pooled rate of TRAEs (any grade) was 84% (95% CI [0.73–0.91]), and the pooled rate of SAEs was 29% (95% CI [0.21–0.38]). Surgical complications pooled rate was 25% (95% CI [0.14–0.41]). The pooled rate of treatment discontinuation (11%, 95% CI [0.09–0.13]), surgical delay (3%, 95% CI [0.02–0.05]), and treatment-related death (2%, 95% CI [0.02–0.03]) were conducted.

Conclusion

Neoadjuvant immunotherapy plus chemotherapy provides a high pathological response, surgical resection rate, R0 resection rate, and pathological downstage rate and has a low risk of increasing the incidence of SAEs, surgical complications, treatment discontinuation, surgical delay, and treatment-related death. The validation of prospective and large sample studies is needed to confirm this conclusion.

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来源期刊

Clinical Respiratory Journal 医学-呼吸系统

CiteScore

3.70

自引率

0.00%

发文量

104

审稿时长

>12 weeks

期刊介绍： Overview Effective with the 2016 volume, this journal will be published in an online-only format. Aims and Scope The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic. We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including: Asthma Allergy COPD Non-invasive ventilation Sleep related breathing disorders Interstitial lung diseases Lung cancer Clinical genetics Rhinitis Airway and lung infection Epidemiology Pediatrics CRJ provides a fast-track service for selected Phase II and Phase III trial studies. Keywords Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease, Abstracting and Indexing Information Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Embase (Elsevier) Health & Medical Collection (ProQuest) Health Research Premium Collection (ProQuest) HEED: Health Economic Evaluations Database (Wiley-Blackwell) Hospital Premium Collection (ProQuest) Journal Citation Reports/Science Edition (Clarivate Analytics) MEDLINE/PubMed (NLM) ProQuest Central (ProQuest) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier)