PD-1/PD-L1抑制剂治疗非小细胞肺癌脑转移患者疗效的Meta分析

目的 对PD-1/PD-L1抑制剂对比化疗治疗非小细胞肺癌(non-small cell lung cancer, NSCLC)脑转移患者的疗效进行Meta分析。方法 计算机检索Pubmed、Embase、Sciencedirect、Cochrane、X-mol、中国知网、万方等数据库的文献,由2名研究者筛选文献、提取资料并对纳入研究进行偏倚风险评估,采用RevMan 5.3软件对NSCLC脑转移患者的整体生存期(overall survival, OS)、无进展生存期(progress free survival, PFS)进行Meta分析。结果 共纳入7篇随机对照试验(randomized controlled trial,RCT),包括451例NSCLC脑转移患者。Meta分析结果显示:与化疗相比,PD-1/PD-L1抑制剂能够显著提高患者的OSHR=0.71,95%CI(0.56,0.92),P=0.008]和PFSHR=0.53,95%CI(0.41,0.69),P<0.01];单纯化疗作为对照组,PD-1/PD-L1抑制剂联合化疗组OSHR=0.41,95%CI(0.24,0.70),P=0.001]、PFSHR=0.44,95%CI(0.30,0.63),P<0.01]比单药组OSHR=0.83,95%CI(0.63,1.11),P=0.21]、PFSHR=0.64,95%CI(0.45,0.91),P=0.01]能够更显著地降低患者的死亡风险和疾病进展风险。结论 PD-1/PD-L1抑制剂单药治疗或联合化疗对于NSCLC脑转移患者对比化疗疗效更好,其中联合化疗组优于单用组,是NSCLC脑转移患者治疗的一个优选方案。

Meta-analysis of PD-1/PD-L1 inhibitors in the treatment of patients with non-small cell lung cancer having brain metastases

Objective To perfrom a meta-analyze of the efficacy of PD-1/PD-L1 inhibitors versus chemotherapy in the treatment of patients with NSCLC brain metastases. Methods Search of the literature included in Pubmed, Embase, Sciencedirect, Cochrane, X-mol, CNKI, Wanfang and other databases on the Internet. Two researchers screened the literature, extracted data and evaluated the risk of bias and adopted RevMan 5.3 performs meta-analysis on the overall survival (OS) and progress free survival (PFS) of NSCLC brain metastasis.Results A total of 7 RCTs were included, including 440 patients with NSCLC brain metastases. Compared with simple chemotherapy group, PD-1/PD-L1 inhibitors could markedly increase the patient's OS HR=0.71, 95%CI(0.56, 0.92), P=0.008] and PFSHR=0.53, 95%CI(0.41, 0.69), P<0.01]; OS HR=0.41, 95%CI(0.24, 0.70), P=0.001] and PFS HR=0.44, 95%CI(0.30, 0.63), P<0.01] in PD-1/PD-L1 inhibitors combined with chemotherapy group compared with OS HR=0.83, 95%CI (0.63, 1.11), P=0.21] and PFSHR=0.64, 95%CI(0.45, 0.91),P=0.01] in the monotherapy group could more significantly reduce the patient's risk of death and disease progression.Conclusion PD-1/PD-L1 inhibitors alone or in combination with chemotherapy for patients with NSCLC brain metastases have better effect than chemotherapy, and the combined chemotherapy group is better than monotherapy, which is a preferred treatment for patients with NSCLC brain metastases.