| Objective: Immune checkpoint inhibitors combined with chemotherapy in the treatment of resectable non-small cell lung cancer has been unable to meet the clinical needs,most patients and clinicians still try to remove cancer tissue and prolong the survival time of patients.At present,a large number of studies on neoadjuvant immunotherapy combined with chemotherapy in the treatment of resectable non-small cell lung cancer are also being carried out,but most of them are single-arm studies,retrospective studies and small clinical trials.Therefore,we conducted this meta-analysis to evaluate the efficacy and safety of immunotherapy combined with chemotherapy in the treatment of resectable NSCLC.Methods: Pub Med,Cochrane Library,WEB OF SCIENCE,EMBASE,CNKI,Wanfang Data,and other databases were searched to collect relevant studies on neoadjuvant immunotherapy combined with chemotherapy in the treatment of resectable non-small cell lung cancer.The Major pathological response rate(MPR),Pathological Complete response rate(PCR),Complete response rate(CR),Partial response(PR),Objective response rate(ORR),Treatment-related adverse events(TRAEs)and surgical resection rates and their 95% confidence intervals(95%CI)were extracted from each study.The retrieval time was from the establishment of the database to May 29,2022.STATA 17 and Revman 5.4 software were used for Meta-analysis.Results: A total of 21 studies involving 1131 patients were included in the meta-analysis after screening by inclusion and exclusion criteria.The results of our analysis showed that in the meta-analysis of individual rates of neoadjuvant immunotherapy plus chemotherapy in resectable NSCLC,CR was(OR=0.09;95%CI,0.06-0.14;P<0.00001),PR was(OR=1.76;95%CI,1.34-2.30;P<0.0001),ORR was(OR=2.16;95%CI,1.61-2.90;P<0.00001),MPR was(OR=1.42;95%CI,1.13-1.79;P=0.0003),PCR was(OR=0.58;95%CI,0.44-0.76;P=0.0001),and the surgical resection rate was(OR=4.61;95%CI,3.08-6.89;P<0.00001),and the total TRAEs were(OR=3.50;95%CI,2.57-4.78,P<0.00001),and TRAEs of grade 3 or above were(OR=0.43;95%CI,0.27-0.66,P=0.0001).After the conversion of the formula,The rate of CR was 8.25%(95%CI,0.05-0.12),the rate of PR was 63%(95%CI,0.57-0.69),and the rate of ORR was 68.3%(95%CI,0.61-0.74),the incidence of MPR was 58.6%(95%CI,0.53-0.64),the incidence of PCR was 36.7%(95%CI,0.30-0.43),the incidence of surgical resection rate rate was82.1%(95%CI,0.75-0.87),The incidence of total TRAEs was 77.8%(95%CI,0.72-0.83),and the incidence of grade 3 or higher TRAEs was 30%(95%CI,0.21-0.40).In the controlled meta-analysis,CR was(OR=2.46;95%CI,0.90-6.76;P=0.08),PR was(OR=5.93;95%CI,3.95-8.91;P<0.00001),ORR was(OR=2.32;95%CI,1.69-3.17;P<0.00001),MPR was(OR=5.93;95% CI,3.95-8.91;P<0.00001),PCR was(OR=11.64;95%CI,5.32-25.46;P<0.00001).Subgroup analysis showed that the CR rate was 3.8%(95%CI,0.02-0.08)in the nonAsian group and 11.5%(95%CI,0.07-0.17)in the Asian group,and the difference was statistically significant.The surgical resection rate was 84%(95%CI,0.78-0.85)in the non-Asian group and 79%(95%CI,0.65-0.89)in the Asian group,with no significant difference.The CR rate was 6.54%(95%CI,0.02-0.14)in the PD-L1 group and 8.26%(95%CI,0.04-0.15)in the PD-1 group,and the difference was not statistically significant.The PCR rate was 22.5%(95%CI,0.16-0.39)in the PD-L1 group and 39.4%(95%CI,0.33-0.46)in the PD-1 group,the difference was not statistically significant.The incidence of grade 3 or higher TRAEs was 17%(95%CI,0.08-0.33)in the PD-L1 group and 34%(95%CI,0.29-0.40)in the PD-1 group,the difference was statistically significant.Conclusion: 1.In terms of PR,ORR,MPR and PCR,neoadjuvant immunotherapy combined with chemotherapy regimen was superior to neoadjuvant chemotherapy regimen.2.In terms of CR,regional grouping is one of the sources of heterogeneity.The neoadjuvant immunotherapy combined with chemotherapy in the Asian group is better than that in the non-Asian group.3.The incidence of grade 3 and above TRAEs in neoadjuvant immunotherapy combined with chemotherapy using PD-L1 was lower than that using PD-1,and there was no significant difference in efficacy and surgical resection rate between the two groups. |
PDF Full Text Request