A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer
Abstract Background Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with different subtypes, multidisciplinary teams-led management, and a poor prognosis. Currently, the clinical benefits of stage III NSCLC in the neoadjuvant setting are still unclear. We performed a meta-ana...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-022-02292-5 |
| _version_ | 1797973815136878592 |
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| author | Wei Liu Tiantian Zhang Qian Zhang Li Li Chunhua Xu |
| author_facet | Wei Liu Tiantian Zhang Qian Zhang Li Li Chunhua Xu |
| author_sort | Wei Liu |
| collection | DOAJ |
| description | Abstract Background Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with different subtypes, multidisciplinary teams-led management, and a poor prognosis. Currently, the clinical benefits of stage III NSCLC in the neoadjuvant setting are still unclear. We performed a meta-analysis of published data on neoadjuvant chemoimmunotherapy in stage III NSCLC to systematically evaluate its efficacy and safety. Methods We searched the databases to identify eligible studies of neoadjuvant chemoimmunotherapy for stage III NSCLC. The primary outcomes mainly included pathological and radiological response outcomes, the feasibility of surgery, and the safety of the regimen. The pathological and radiological response included the rate of major pathologic response (MPR), complete pathologic response (pCR), radiological response outcomes, and R0 resection; The feasibility included the rate of surgical resection, conversion to thoracotomy, surgical complications, pathological downstaging of clinical disease stage. The safety included the incidence of treatment-related adverse events (TRAEs) and severe adverse events (SAEs). R 4.1.3 software was conducted for data analysis, and p < 0.05 was considered statistically significant. Results Nine trials containing a total of 382 populations were eligible for the meta-analysis, with the pooled surgical resection rate of 90%. Owing to the large heterogeneity of the single-rate meta-analysis, the random effect model was adopted. The estimated pooled prevalence of MPR was 56% (95%CI 0.39–0.72) and of pCR was 39% (95%CI 0.28–0.51). The pooled rate of TRAEs was 65% (95%CI 0.17–0.99) and SAEs was 24% (95%CI 0.05–0.49). Conclusion Compared to neoadjuvant chemotherapy or immunotherapy, neoadjuvant chemoimmunotherapy achieved more pathological and radiological relief, and has a high surgical resection rate and low risk of conversion to thoracotomy and surgical complications, with poor tolerance of toxicity but rarely developing life-threatening adverse events. In conclusion, neoadjuvant chemoimmunotherapy is suggested to be beneficial for stage III NSCLC. |
| first_indexed | 2024-04-11T04:10:15Z |
| format | Article |
| id | doaj.art-f535cd677c854dd4a9c4cf5ece8f9bb3 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-11T04:10:15Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-f535cd677c854dd4a9c4cf5ece8f9bb32023-01-01T12:12:17ZengBMCBMC Pulmonary Medicine1471-24662022-12-012211910.1186/s12890-022-02292-5A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancerWei Liu0Tiantian Zhang1Qian Zhang2Li Li3Chunhua Xu4Department of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityDepartment of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityDepartment of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityDepartment of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityDepartment of Respiratory Medicine, The Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityAbstract Background Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease with different subtypes, multidisciplinary teams-led management, and a poor prognosis. Currently, the clinical benefits of stage III NSCLC in the neoadjuvant setting are still unclear. We performed a meta-analysis of published data on neoadjuvant chemoimmunotherapy in stage III NSCLC to systematically evaluate its efficacy and safety. Methods We searched the databases to identify eligible studies of neoadjuvant chemoimmunotherapy for stage III NSCLC. The primary outcomes mainly included pathological and radiological response outcomes, the feasibility of surgery, and the safety of the regimen. The pathological and radiological response included the rate of major pathologic response (MPR), complete pathologic response (pCR), radiological response outcomes, and R0 resection; The feasibility included the rate of surgical resection, conversion to thoracotomy, surgical complications, pathological downstaging of clinical disease stage. The safety included the incidence of treatment-related adverse events (TRAEs) and severe adverse events (SAEs). R 4.1.3 software was conducted for data analysis, and p < 0.05 was considered statistically significant. Results Nine trials containing a total of 382 populations were eligible for the meta-analysis, with the pooled surgical resection rate of 90%. Owing to the large heterogeneity of the single-rate meta-analysis, the random effect model was adopted. The estimated pooled prevalence of MPR was 56% (95%CI 0.39–0.72) and of pCR was 39% (95%CI 0.28–0.51). The pooled rate of TRAEs was 65% (95%CI 0.17–0.99) and SAEs was 24% (95%CI 0.05–0.49). Conclusion Compared to neoadjuvant chemotherapy or immunotherapy, neoadjuvant chemoimmunotherapy achieved more pathological and radiological relief, and has a high surgical resection rate and low risk of conversion to thoracotomy and surgical complications, with poor tolerance of toxicity but rarely developing life-threatening adverse events. In conclusion, neoadjuvant chemoimmunotherapy is suggested to be beneficial for stage III NSCLC.https://doi.org/10.1186/s12890-022-02292-5Neoadjuvant chemoimmunotherapyNon-small cell lung cancerStage IIISafety and efficacy |
| spellingShingle | Wei Liu Tiantian Zhang Qian Zhang Li Li Chunhua Xu A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer BMC Pulmonary Medicine Neoadjuvant chemoimmunotherapy Non-small cell lung cancer Stage III Safety and efficacy |
| title | A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer |
| title_full | A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer |
| title_fullStr | A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer |
| title_full_unstemmed | A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer |
| title_short | A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer |
| title_sort | systematic review and meta analysis of neoadjuvant chemoimmunotherapy in stage iii non small cell lung cancer |
| topic | Neoadjuvant chemoimmunotherapy Non-small cell lung cancer Stage III Safety and efficacy |
| url | https://doi.org/10.1186/s12890-022-02292-5 |
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