肿瘤突变负荷对PD-1/PD-L1抑制剂治疗非小细胞肺癌临床疗效预测的Meta分析

沈仕俊; 王巧丽; 杨金江; 李国剑; 李孟丽; 张小丽; 甘平

doi:10.3971/j.issn.1000-8578.2021.20.0765

肿瘤突变负荷对PD-1/PD-L1抑制剂治疗非小细胞肺癌临床疗效预测的Meta分析

Predictive Value of Tumor Mutation Burden for PD-1/PD-L1 Inhibitors Treatment on Non-small Cell Lung Cancer: A Meta-analysis

摘要

摘要:
目的探讨肿瘤突变负荷(TMB)与PD-1/PD-L1抑制剂治疗非小细胞肺癌(NSCLC)疗效的相关性。
方法系统检索PubMed、Embase和Cochrane Library、CNKI、中国生物医学数据库(Chinese Biomedical Literature Database, CBM)和万方数据库，检索日期截至2020年3月25日。RevMan5.3和STATA15.0进行分析。
结果纳入12项研究，共计1209例患者。结果提示TMB显著提高PD-1/PD-L1抑制剂治疗过的NSCLC疾病无进展生存期(PFS)(HR=0.54, 95%CI: 0.42~0.70, P＜0.001)，但TMB却降低客观缓解率(ORR)(OR=4.41, 95%CI: 2.54~7.63, P＜0.001)。亚组分析结果显示，TMB对PD-1/PD-L1抑制剂联合抗CTLA-4抑制剂或化疗治疗的非小细胞肺癌的预测价值显著。Begg's检验和Egger's检验未观察到显著的发表偏倚。
结论高TMB可预测PD-1/PD-L1抑制剂治疗非小细胞肺癌PFS的提高，但对OS、ORR及长期生存的预测价值需进一步研究。

Abstract:
Objective To investigate the relation between TMB and the efficiency of PD-1/PD-L1 inhibitors treatment for non-small-cell lung cancer.
Methods Studies were searched from PubMed, Embase, Cochrane Library database, Chinese Biomedical Literature Database and Wanfang Database up to March 25, 2020. RevMan 5.3 software and STATA15.0 were used for analysis.
Results Twelve literatures were involved, including 1209 patients. TMB significantly improved PFS (HR=0.54, 95%CI: 0.42-0.70, P < 0.001) but reduced the ORR (OR=4.41, 95%CI: 2.54-7.63, P < 0.001) of NSCLC patients treated with PD-1/PD-L1 inhibitors. The subgroup analyses showed that the predictive value of TMB was significant in non-small cell lung cancer treated by PD-1/PD-L1 inhibitors combined with anti-CTLA-4 therapy or chemotherapy. No significant publication bias was observed by the Begg's test and Egger's test.
Conclusion High tumor mutation burden may predict the improved PFS of non-small cell lung cancer by PD-1/PD-L1 inhibitors treatment, but its predictive value for OS, ORR and long-term survival need more exploration.

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