激素预处理对非小细胞肺癌患者免疫检查点抑制剂疗效和安全性影响的网状Meta分析

目的：采用网状Meta分析的方法对非小细胞肺癌患者激素预处理下免疫检查点抑制剂疗效和安全性进行评价。方法：检索PubMed、EMbase、Cocharane、万方、维普、中国知网、中国生物医学文献数据库关于免疫检查点抑制剂联合紫杉醇对比联合白蛋白结合型紫杉醇治疗非小细胞肺癌的大型多中心随机对照试验（RCT），检索时间为建库至2019年6月。以Stata13.0软件、R-3.6.1软件、WinBUGS软件进行网状Meta分析。结果：最终纳入8项RCT，4项干预措施（免疫检查点抑制剂+铂类+白蛋白结合型紫杉醇，免疫检查点抑制剂+铂类+普通紫杉醇，铂类+白蛋白结合型紫杉醇，铂类+普通紫杉醇），包含4 005例患者。分析结果显示，在总生存期[HR=0.88，95%CI（0.67，1.17）]及无进展生存期[HR=0.87，95%CI（0.57，1.32）]方面，免疫检查点抑制剂联合铂类+白蛋白结合型紫杉醇与免疫检查点抑制剂联合铂类+紫杉醇相比，差异无统计学意义；在安全性方面，3级及以上不良反应率激素预处理组与未处理组差异无统计学意义。结论：激素预处理对免疫检查点抑制剂的疗效以及安全性无影响，需纳入直接比较研究进一步验证。

Impact of hormonal preconditioning on efficacy and safety of immune checkpoint inhibitors in patients with non-small-cell lung cancer: A network meta-analysis

OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors under hormone pretreatment in patients with non-small cell lung cancer using reticular meta-analysis.METHODS PubMed, EMbase, Cocharane, Wanfang, VIP, CNKI and Chinese biomedical literature databases were searched for large multicenter randomized controlled trials (RCTs) of immune checkpoint inhibitors combined with paclitaxel versus nab-paclitaxel in the treatment of cell lung cancer from inception to June 2019.Stata13.0 software, R-3.6.1 software, and WinBUGS software were used for mesh meta-analysis.RESULTS Eight RCTs and four interventions were finally included (immune checkpoint inhibitor + platinum + albumin-bound paclitaxel, immune checkpoint inhibitor + platinum + ordinary paclitaxel, platinum + albumin-bound paclitaxel, platinum Class + general paclitaxel), involving a total 4005 patients. The analysis results show that in terms of overall survival[HR=0.88,95% CI( 0.67, 1.17)]and progression-free survival [HR=0.87,95% CI(0.57, 1.32)], there was no statistical difference between immune checkpoint inhibitorscombined withplatinum + albumin-bound paclitaxel and immune checkpoint inhibitors combined with platinum + paclitaxel; in terms of safety, grade 3 and higher adverse reaction rates were not statistically different between the hormone pretreated group and the untreated group.CONCLUSION Hormone pretreatment has no effect on the efficacy and safety of immune checkpoint inhibitors and needs to be included in direct comparative studies for further verification.