Meta-analysis Of The Influence Of Concomitant Gastric Acid Suppressants Use On The Survival Of Patients With Non-small Cell Lung Cancer Treated With PD-1/PD-L1 Inhibitors

Objective:The purpose of this study was to summarize the existing studies on the effect of gastric acid inhibitors on the survival of patients with non-small cell lung cancer treated with PD-1/PD-L1 inhibitors for meta-analysis,and discuss the impact of gastric acid inhibitors on the survival of patients with non-small cell lung cancer treated with PD-1/PD-L1 inhibitors,so as to provide some guidance for immunotherapy of NSCLC.Methods:The related literatures about the effect of gastric acid inhibitors on the survival of patients with non-small cell lung cancer treated with PD-1/PD-L1 inhibitors published as of May 26,2022 were retrieved in Medline,Embase and Web of Science databases.First,the research quality of the included literature was evaluated by Newcastle Ottawa Scale(NOS).Then the data were extracted,and the random effect models were selected for meta-analysis using Rev Man and STATA software.Cochran’s Q test and I~2test were used to evaluate the heterogeneity among the included studies,and sensitivity analysis was conducted by eliminating individual studies one by one to investigate the source of heterogeneity and the stability of research results.Then a funnel chart and Egger’s test were constructed to evaluate publication bias.Results:Eleven eligible articles were screened,including 10 retrospective studies and 1prospective cohort study,including 5892 patients.The NOS score showed that the selected literature was of good quality.Meta analysis results showed that in NSCLC patients receiving PD-1/PD-L1 inhibitors,the use of GAS at the same time significantly reduced the progression free survival(HR=1.32,95%CI:1.20-1.45,P<0.001;I~2=0%)and total survival(HR=1.36,95%CI:1.26-1.48,P<0.001;I~2=0%).Subgroup analysis showed that,in both univariate and multivariate studies,the correlation between the simultaneous use of GAS and the reduction of survival in NSCLC patients receiving PD-1/PD-L1 inhibitors was consistent,and there was no difference between subgroups.There was no publication bias in this study,and the results were stable.Conclusions:The meta-analysis of the latest literature shows that the use of GAS(mainly proton pump inhibitor)was associated with adverse survival outcomes in NSCLC patients receiving PD-1/PD-L1 inhibitors.This was of great significance for the treatment of non-small cell lung cancer.