■本研究评估了不同新辅助免疫治疗周期和方案对非小细胞肺癌的应用。
■在数据库中搜索直到2023年12月发表的文章。主要病理反应(MPR)的数据,完全病理反应(pCR),放射学响应,治疗相关不良事件(TRAEs),严重不良事件(SAE),手术切除,手术并发症,R0切除,收集并转换为开胸手术。根据治疗方案和周期进行亚组分析。Stata/MP软件用于统计分析。
■总共,从44项研究中评估了2430名个体。与单纯的新辅助免疫治疗相比(MPR/pCR/TRAEs/SAEs:ES=0.26/0.07/0.43/0.08,95%CI:0.18-0.34/0.04-0.10/0.28-0.58/0.04-0.14),MPR和pCR率,新辅助化学免疫治疗后TRAE和SAE的发生率显著增加(MPR/pCR/TRAEs/SAEs:ES=0.55/0.34/0.81/0.22,95%CI:0.48~0.63/0.28~0.41/0.69~0.90/0.13~0.33,P=0.001/0.002/0.009/0.034).在手术切除中没有发现显著差异,手术并发症,R0切除,或转换为开胸手术。在化学免疫疗法组中,MPR和pCR率无统计学差异,双周期中TRAE和SAE的发生率,三周期和四周期组(MPR/pCR/TRAEs/SAEs:ES=0.50;0.70;0.36/0.32;0.49;0.18/0.95;0.85;0.95/0.34;0.27;0.37,P=0.255/0.215/0.253/0.848)。在ICIs组中,MPR和pCR率几乎没有变化,与三周期组相比,两周期组的TRAE和SAE发生率。(MPR/pCR/TRAEs/SAEs:ES=0.28;0.20/0.06;0.08/0.45;0.35/0.10;0.02,P=0.696/0.993/0.436/0.638)。新辅助治疗周期对手术切除无明显影响,手术并发症,R0切除,或在两种方案中转换为开胸手术。
■新辅助化学免疫疗法与单纯新辅助免疫疗法相比,显著提高了肿瘤病理缓解率,但同时也增加了TRAE和SAE的发生率。发现新辅助化学免疫疗法的有效性和安全性在持续三个周期的给药时是有利的。与两个和四个周期相比。
■https://www.crd.约克。AC.uk/PROSPERO/#recordDetails,标识符CRD42023407415。
UNASSIGNED: This study evaluated the use of different neoadjuvant immunotherapy cycles and regimens for non-small cell lung cancer.
UNASSIGNED: Databases were searched for articles published up until December 2023. Data on the major pathologic response (MPR), complete pathologic response (pCR), radiological response, treatment-related adverse events (TRAEs), serious adverse events (SAEs), surgical resection, surgical complications, R0 resection, and conversion to thoracotomy were collected. A subgroup analysis was performed according to the treatment regimens and cycles. Stata/MP software was used for statistical analyses.
UNASSIGNED: In total, 2430 individuals were assessed from 44 studies. Compared with those following neoadjuvant immunotherapy alone (MPR/pCR/TRAEs/SAEs: ES=0.26/0.07/0.43/0.08, 95% CI: 0.18-0.34/0.04-0.10/0.28-0.58/0.04-0.14), the MPR and pCR rates, incidence of TRAEs and SAEs following neoadjuvant chemoimmunotherapy increased significantly (MPR/pCR/TRAEs/SAEs: ES=0.55/0.34/0.81/0.22, 95% CI: 0.48-0.63/0.28-0.41/0.69-0.90/0.13-0.33, P=0.001/0.002/0.009/0.034). No significant differences were found in the surgical resection, surgical complications, R0 resection, or conversion to thoracotomy. In the chemoimmunotherapy group, no statistically significant differences were found in the MPR and pCR rates, incidence of TRAEs and SAEs in the two-cycle, three-cycle and four-cycle groups (MPR/pCR/TRAEs/SAEs: ES=0.50;0.70;0.36/0.32;0.49;0.18/0.95;0.85;0.95/0.34;0.27;0.37, P=0.255/0.215/0.253/0.848). In the ICIs group, there was little change in the MPR and pCR rates, incidence of TRAEs and SAEs in the two-cycle group compared to the three-cycle group. (MPR/pCR/TRAEs/SAEs: ES=0.28;0.20/0.06;0.08/0.45;0.35/0.10;0.02, P=0.696/0.993/0.436/0.638). The neoadjuvant treatment cycle had no significant effect on surgical resection, surgical complications, R0 resection, or conversion to thoracotomy in both regimens.
UNASSIGNED: Neoadjuvant chemoimmunotherapy significantly increased the rate of tumor pathological remission compared to neoadjuvant immunotherapy alone but also increased the incidence of TRAEs and SAEs. The efficacy and safety of neoadjuvant chemoimmunotherapy are found to be favorable when administered for a duration of three cycles, in comparison to both two and four cycles.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023407415.