背景:高级别神经胶质瘤(HGG)是侵袭性最强的原发性脑肿瘤,尽管常规治疗,预后较差。由于其引发针对肿瘤细胞的靶向免疫应答的潜力,免疫疗法已成为有希望的途径。
目的:本荟萃分析旨在评估各种免疫治疗策略的有效性和安全性,包括免疫检查点抑制剂(ICI),病毒疗法,和树突细胞疫苗(DCV)在治疗HGG。
方法:遵循PRISMA框架,我们搜索了PubMed,科克伦,和Embase用于报告接受免疫治疗的HGG患者结局的研究。关键指标包括总生存率,无进展生存期,和治疗相关的不良事件。
结果:我们回顾了47项研究,分析3674例接受免疫治疗的HGG患者的数据。ICI治疗患者的平均总生存期为11.05个月,在11.79个月时进行病毒治疗,DCV在24.11个月时明显更长。ICIs的平均无进展生存期(PFS)为3.65个月。病毒疗法显示PFS有利于对照组,表示影响最小,而DCV显示PFS显著改善,与对照组相比,风险中位数降低0.43倍(95%CI:29-64%).ICI的不良事件主要为1级或2级,包括病毒治疗的5级事件。DCV主要是1级或2级,表明良好的安全性。
结论:免疫治疗作为HGG的有效治疗方法具有潜力,尤其是DCV。然而,结果因治疗类型和个体患者资料的不同而显著不同.需要进一步的随机对照试验来建立可靠的临床指南并优化治疗方案。
BACKGROUND: High-grade gliomas (HGG) are the most aggressive primary brain tumors with poor prognoses despite conventional treatments. Immunotherapy has emerged as a promising avenue due to its potential to elicit a targeted immune response against tumor cells.
OBJECTIVE: This meta-analysis aimed to evaluate the efficacy and safety of various immunotherapeutic strategies, including immune checkpoint inhibitors (ICI), virotherapy, and dendritic cell vaccines (DCV) in treating HGG.
METHODS: Following the PRISMA framework, we searched PubMed, Cochrane, and Embase for studies reporting outcomes of HGG patients treated with immunotherapy. Key metrics included overall survival, progression-free survival, and treatment-related adverse events.
RESULTS: We reviewed 47 studies, analyzing data from 3674 HGG patients treated with immunotherapy. The mean overall survival for patients treated with ICI was 11.05 months, with virotherapy at 11.79 months and notably longer for DCV at 24.11 months. The mean progression-free survival (PFS) for ICIs was 3.65 months. Virotherapy demonstrated a PFS favoring the control group, indicating minimal impact, while DCV showed substantial PFS improvement with a median of 0.43 times lower hazard compared to controls (95% CI: 29-64%). Adverse events were primarily Grade 1 or 2 for ICI, included a Grade 5 event for virotherapy, and were predominantly Grade 1 or 2 for DCV, indicating a favorable safety profile.
CONCLUSIONS: Immunotherapy holds potential as an effective treatment for HGG, especially DCV. However, results vary significantly with the type of therapy and individual patient profiles. Further randomized controlled trials are necessary to establish robust clinical guidelines and optimize treatment protocols.