Meta Analysis Of The Efficacy And Safety Of Neoadjuvant Immunotherapy Combined With Chemotherapy For Stage Ⅲ Non Small Cell Lung Cancer

Objective:To analyze the efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy for stage III non small cell lung cancer.Methods:Computer retrieval of databases such as Pub Med,Embase,and Cochrane Library was conducted.The publication time range of the literature was from the establishment of the database to June 2022.The literature was screened,the quality of the literature was evaluated,and relevant data were extracted.Statistical software Stata/SE15.1 and SPSS26 were used for analysis.Results:A total of 21 articles were included,of which 11 articles were included in the neoadjuvant immunochemotherapy group,with a total of 433 patients.The meta-analysis results showed that the surgical resection rate was 89%,(95%CI:75%～98%,I~2=91.8%).Compared with neoadjuvant chemotherapy,neoadjuvant immunochemotherapy increased the surgical resection rate of stage III NSCLC,with a statistically significant difference between P<0.05;The CPR rate was 34%(95%CI:23%～45%,I~2=77.27%),which significantly improved the complete pathological response of stage III NSCLC compared to neoadjuvant chemotherapy alone(P<0.05);The pathological decline rate was 81%(95%CI:72%～89%,I~2=58.62%),which significantly decreased the pathological stage of stage III NSCLC compared to neoadjuvant chemotherapy alone(P<0.05);The R0 resection rate was 99%(95%CI:97%～100%,I~2=0),significantly higher than neoadjuvant chemotherapy alone in patients with stage III NSCLC(P<0.05);The death rate within 30 days after surgery was 0.00,and there was no difference compared with neoadjuvant chemotherapy alone(P>0.05)The incidence of grade 3 TRAE was 21%(95%CI:5%～44%,I~2=94.94%),and compared with neoadjuvant chemotherapy alone,it did not increase≥grade 3 TRAE in patients with stage III NSCLC(P>0.05,no difference);The incidence of pneumonectomy was 7%(95%CI:4%～11%),which significantly reduced the incidence of pneumonectomy in patients with stage III NSCLC compared to neoadjuvant chemotherapy alone(P<0.05);The incidence of sleeve lobectomy was 18%(95%CI:7%to 31%,I~2=69.14%),which was not significantly different from neoadjuvant chemotherapy alone and did not increase the incidence of sleeve lobectomy in patients with stage III NSCLC(P>0.05);The interval between the last treatment and surgery was 35.6 days(95%CI:29.9-41.3,I~2=85.4%);The MPR rate was67%(95%CI:62%～73%,I~2=39.28%);The thoracotomy rate was 60%(95%CI:24%～91%,I~2=96.06%);The operation time was 214.1 minutes(95%CI:193.1～235.0,I~2=20%);Intraoperative bleeding was 236.1 ml(95%CI:108.1～364.1,I~2=23.8%).Conclusion:Neoadjuvant immunotherapy combined with chemotherapy is feasible,effective,and relatively safe for patients with stage III NSCLC.However,due to the small sample single arm study included in the neoadjuvant immunotherapy group and the limited follow-up period,more high-quality studies and longer observation time need to be included to further demonstrate.