免疫检查点抑制剂治疗肺癌的Meta分析

A Meta-Analysis of Immune Checkpoint Inhibitors in the Treatment of Lung Cancer

摘要: 目的：本研究目的在于系统评价及对比免疫检查点抑制剂及单纯化疗治疗肺癌的疗效及安全性。方法：计算机检索中国期刊全文数据库、万方数据库、The Cochrane Library、PubMed、CBM、维普数据库等数据库，搜索免疫检查点抑制剂及单纯化疗治疗肺癌的随机对照试验(randomized control trial, RCT)；主要结局指标包括总生存期(overall survival, OS)、无进展生存时间(progression free survival, PFS)、有效率及治疗相关3~4级不良反应；采用RevMan5.2软件进行meta分析。结果：共纳入6个RCT，2509例晚期肺癌患者。meta分析结果显示：与化疗组相比，免疫检查点抑制剂可显著提高肺癌患者的有效率(RR = 1.48, P < 0.05, 95%CI: 1.08~2.03)，显著延长患者的无进展生存期(HR = 0.83, P < 0.0001, 95%CI: 0.77~0.91)，显著延长患者的总生存期(HR = 0.71, P < 0.00001, 95%CI: 0.65~0.78)，并不显著降低患者治疗相关3~4级不良反应(RR = 0.43, P = 0.08, 95%CI: 0.17~1.09)。结论：与单纯化疗相比较，免疫检查点抑制剂治疗肺癌可以提高晚期肺癌患者的有效率、PFS及OS。

Abstract: Objective: To systematically review the efficacy and safety of immune checkpoint inhibitors in the treatment of lung cancer. Methods: The PubMed, CBM, CNKI, VIP, Wan Fang and The Cochrane Li-brary were retrieved by computer, the randomized controlled trials (RCT) about immune check-point inhibitors in the treatment of lung cancer were collected by us. The outcomes included overall survival (OS), progression-free survival (PFS), response rate and treatment-related adverse events of grade 3 or 4; RevMan5.2 software was used for Meta analysis. Results: Six trials and 2509 lung cancer patients were included. Meta analysis indicated that compared with chemotherapy alone, the immune checkpoint inhibitors could increase the response rate of the patient (RR = 1.48, P < 0.05, 95%CI: 1.08~2.03), significantly prolong the progression-free survival of the patients (HR = 0.83, P < 0.0001, 95%CI: 0.77~0.91), significantly prolong the overall survival of the patients (HR = 0.71, P < 0.00001, 95%CI: 0.65~0.78), did not significantly reduce the treatment- related adverse events of grade 3 or 4 (RR = 0.43, P = 0.08, 95%CI: 0.17~1.09). Conclusions: Immune checkpoint in-hibitor can obviously improve the response rate, PFS and OS of patients with advanced lung cancer, better than chemotherapy alone.