Effects Of Antibacterials On The Immunotherapy Of NSCLC:A Meta-analysis

Objective:To systematically review the effects of antibacterials on overall survival（OS）and progression free survival（PFS）in patients suffering from non-small cell lung cancer（NSCLC）and receiving ICIs therapy.Methods: Search CNKI,Wanfang,VIP,CBM,Pub Med,EMBASE,Cochrane Library and Web of Science databases.The retrieval time limit is from the establishment of the database to December 2021.Collect relevant studies on the impact of antibiotics on the immune efficacy of NSCLC patients,and extract data according to the inclusion and exclusion criteria.Newcastle-Ottawa scale（NOS）was used to evaluate the quality of included literatures.Hazard ratio（HR）was applied as the effect size.Meta-analysis was performed by using Rev Man 5.3 software,Stata 15.0 software were used for sensitivity analysis.Results: Twenty-five studies involving 4891 NSCLC patients were enrolled.Meta analysis displayed that OS[HR=1.63,95% CI（1.31,2.04）,P<0.0001] and PFS[HR=1.43,95% CI（1.20,1.70）,P<0.0001] were significantly lower in patients being treated with ICIs and exposed to ATB.Subgroup analysis based on the types of ICIs treatment drugs showed that exposure to ATB was significantly correlated with OS and PFS in PD-1 group alone and PD-1、PD-L1、CTLA-4 groups in different ways during treatment（P<0.05）,while was no effect on OS and PFS in PD-L1 treatment group（P>0.05）.Subgroup analysis based on the use time of ATB showed that the use of ATB during ICIs treatment had no significant impact on OS and PFS（P>0.05）,while the use of ATB within 1 month before ICIs treatment had the greatest impact on OS and PFS（P<0.05）.The use of ATB 1 ～ 3 months before and after ICIs treatment significantly affected OS and PFS（P<0.05）.Based on the subgroup analysis of ATB type,the results showed that the more kinds of ATB drugs,the greater impact on OS in NSCLC patients treated with ICIs（P<0.05）,but there was no significant correlation with PFS（P>0.05）.The results of sensitivity analysis show that excluding the literature in this study one by one will not affect the research results,which means that the calculation results are stable and reliable.The results of publication bias test show that the funnel diagram of this study is basically symmetrical,which can judge that there is no obvious publication bias in the literature of this study.Conclusion: This Meta-analysis showed that the use of ATB was negatively correlated with OS and PFS in NSCLC patients receiving ICIs immunotherapy.