目的 系统评价免疫检查点抑制剂(ICIs)治疗肾细胞癌致免疫相关不良反应(irAEs)与预后的相关性.方法 计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方、维普、中国生物医学文献服务系统数据库自建库至2023年10月28日发表的关于ICIs治疗肾细胞癌致irAEs与预后相关性的临床研究.采用纽卡斯尔-渥太华量表对纳人文献质量进行评价,采用RevMan 5.4软件进行Meta分析.结果 共纳入15篇回顾性研究,涉及1781例患者.Meta分析结果显示,在接受ICIs治疗的肾细胞癌患者中,irAEs的发生与更好的客观反应率(ORR)(P＜0.01)、疾病控制率(DCR)(P＜0.01)、无进展生存期(PFS)(P＜0.01)和总生存期(OS)(P＜0.01)显著相关.轻度(1～2级)irAEs及数量≥2种irAEs的发生与PFS和OS的改善显著相关(P＜0.01).然而,器官特异性irAEs及重度(3～4级)irAEs发生与OS和PFS的改善无统计学相关性(P＞0.05).根据地理区域、ICI类型进行的亚组分析结果显示,美国、意大利地区和仅接受抗PD-1/PD-L1治疗的患者,都显示irAEs发生与更好的PFS和OS相关(P＜0.01);联合使用抗PD-1和抗CTLA-4治疗的患者,显示irAEs发生与更好的OS相关(P＜0.01).敏感性分析结果显示,所得结果较稳健.发表偏倚分析结果显示,本研究可能存在一定的发表偏倚.结论 ICI治疗肾细胞癌致irAEs发生与其更好的ORR、DCR、PFS和OS有关,轻度(1～2级)irAEs及数量≥2种irAEs的发生与PFS和OS的改善相关.irAEs可能是ICIs治疗肾细胞癌疗效的预测因子.
Meta-analysis of the correlation between immune-related adverse events and prognosis of immune checkpoint inhibitors for renal cell carcinoma
Objective To systematically evaluate the relationship between immune-related adverse events(irAEs)and prognosis of immune checkpoint inhibitors(ICIs)in the treatment of renal cell carcinoma(RCC).Methods PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang database,VIP and CBM were searched to collect prospective or retrospective cohort studies on the correlation between irAEs and prognosis of ICIs for RCC.The retrieval time was from the inception to October 28,2023.Newcastle-Ottawa scale was used to evaluate the quality of included literatures.Meta-analysis was performed by RevMan 5.4 software.Results Totally 15 retrospective studies involving 1781 patients.The meta-analysis showed that the occurrence of irAEs was significantly associated with better objective response rate(ORR)(P＜0.01),disease control rate(DCR)(P＜0.01),progression-free survival(PFS)(P＜0.01)and overall survival(OS)(P＜0.01)in patients with RCC receiving ICIs.The occurrence of mild(grade 1～2)and≥2 kinds of irAEs was significantly associated with the improvement of PFS and OS(P＜0.01),while the occurrence of organ-specific irAEs and severe irAEs(grade 3～4)was not significantly associated with the improvement of OS and PFS(P＞0.05).Subgroup analysis based on geographic regions and ICI types showed that irAEs were associated with better PFS and OS in patients receiving only anti-PD-1/PD-L1 therapy in the United States and Italy(P＜0.01),while irAEs were associated with better OS in patients receiving combination therapy of anti-PD-1 and anti-CTLA-4(P＜0.01).Sensitivity analysis showed relatively robust results in the above-mentioned meta-analysis.The results of the publication bias analysis showed possible publication bias in this study.Conclusion ICIs for RCC resulted in irAEs associated with better ORR,DCR,PFS and OS.The occurrence of mild(grade 1～2)and≥2 kinds of irAEs is associated with improved PFS and OS,so irAEs may be a predictor of the efficacy of ICIs for RCC.
NETL
NSTL
万方数据
