早期可手术切除的非小细胞肺癌新辅助治疗方案的疗效和安全性网状meta分析

Efficacy and safety of neoadjuvant treatment regimens for early resectable non-small cell lung cancer:a network Meta-analysis

目的探讨早期可手术切除的非小细胞肺癌新辅助治疗方案的疗效和安全性。方法检索PubMed、Embase、MEDLINE、Cochrane Library等数据库,纳入与新辅助治疗相关的临床试验。提取各种治疗方案的病理完全缓解、无事件生存期、不良事件发生率等数据,应用R4.3.2软件进行网状meta分析。结果共纳入10项随机对照试验,共3650例患者和5种新辅助治疗方案。新辅助化学免疫治疗患者病理完全缓解、无事件生存期均明显优于新辅助化学治疗(相对危险度/风险比=7.18、0.60,95%可信区间2.96~18.60、0.37~0.97);各治疗方案3级及以上不良事件发生率比较,差异无统计学意义(P>0.05)。结论早期可手术切除的非小细胞肺癌患者给予新辅助免疫治疗联合化疗能提高其病理缓解、生存获益,但新辅助治疗后增加辅助免疫治疗在生存获益方面并无明显差异。

Objective To investigate the efficacy and safety of neoadjuvant treatment regimens for early resectable non-small cell lung cancer.Methods PubMed,Embase,MEDLINE,Cochrane Library and other databases were searched to include clinical trials related to neoadjuvant therapy.Data such as pathological complete response,event-free survival,and incidence of adverse events of various treatment regimens were extracted,and network meta-analysis was performed using R4.3.2 software.Results A total of 10 randomized controlled trials involving 3650 patients and five neoadjuvant treatment regimens were included.Neoadjuvant chemoinunotherapy significantly improved pathological complete response and event-free survival compared to neoadjuvant chemotherapy alone(relative risk/hazard ratio=7.18,0.60;95%CI 2.96-18.60,0.37-0.97).There was no significant difference in the incidence of Grade 3 or higher adverse events among the treatment regimens(P>0.05).Conclusion For patients with early resectable non-small cell lung cancer,neoadjuvant immunotherapy combined with chemotherapy can enhance pathological remission and survival benefits.However,the addition of adjuvant immunotherapy following neoadjuvant treatment does not show a significant difference in survival benefits.