| Objective: This article aimed to conduct a meta-analysis of the efficacy of immune checkpoint inhibitors(ICIs)versus chemotherapy in patients with advanced non-small cell lung cancer(NSCLC)at different ages.Methods: We searched Pubmed,Cochrane Library,Embase,Sino Med,CNKI,Wanfang,Metstr and other databases,as well as manually retrieved books and journals,and searched the studies on the efficacy of ICIs for advanced NSCLC patients published before 31 st September,2020.According to the literature screening criteria,eligible randomized controlled studies were included,and the quality of the included studies was evaluated using the Cochrane risk bias assessment tool by two reaseachers independently.After data extraction and analysis,Rev Man 5.3 software was used to perform a meta-analysis of the efficacy of ICIs versus chemotherapy in advanced NSCLC patients at different ages.Then we conducted heterogeneity test and sensitivity analysis,and used Stata13.0 software to test the publication bias of this study.Results:A total of 605 articles were retrieved,and 14 studies were eventually included,all of which were randomized controlled trials.The results showed that ICIs had a significant advantage over chemotherapy in patients with advanced NSCLC.For OS,when patients’ age were less than 65 years,a longer OS was observed in ICIs group(HR=0.74,95%CI:0.64-0.86,P<0.0001).Subgroup analysis further suggested that in stage IV NSCLC patients who were younger than 65 years,compared with chemotherapy alone,patients treated with ICIs combined with chemotherapy had a longer OS in first-line therapy.ICIs still showed longer OS in some patients older than 65years(65-74years: HR=0.78,95%CI:0.66-0.91,P=0.002).However,there was no significant difference between ICIs and chemotherapy when patients’ age were older than 75 years(HR=0.87,95%CI:0.71-1.07,P=0.18).For PFS,there were statistically significant differences among all age groups(<65years: HR=0.64,95%CI:0.48-0.85,P=0.002;≥65 years: HR=0.75,95%CI:0.58-0.97,P=0.03;≥75years: HR=0.49,95%CI:0.30-0.79,P=0.004).Subgroup analysis also found that patients treated with ICIs combined with chemotherapy had longer PFS than chemotherapy,regardless of PD-L1 expression status.Moreover,ICI alone had a similar incidence of adverse events(AEs)in elderly and non-elderly groups.Conclusions:1.In advanced NSCLC patients younger than 75 years,ICIs had longer survival time than chemotherapy.Especially in the first-line treatment,ICIs had greater advantages,and patients with PD-L1 expression<1%could also benefit from ICIs.2.In advanced NSCLC patients who were 75 years or older,there was no statistically significant difference between ICIs and chemotherapy.Therefore,if the patient is 75 years old or over 75 years,the application of ICIs should weigh the pros and cons,and choose the best treatment plan based on individual differences. |
