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不可逆电穿孔联合免疫治疗对不可切除胰腺癌有效性和安全性的Meta分析

叶舰 杨峻峰 杜丽文 刘建生

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不可逆电穿孔联合免疫治疗对不可切除胰腺癌有效性和安全性的Meta分析

DOI: 10.12449/JCH241122
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:叶舰负责研究设计,数据整理,统计学分析和论文撰写;杨峻峰、杜丽文负责数据整理和统计学分析;刘建生负责研究设计,论文指导和论文修改。
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    通信作者:

    刘建生, 147542533@qq.com (ORCID: 0000-0002-6038-2560)

Efficacy and safety of irreversible electroporation combined with immunotherapy in treatment of unresectable pancreatic cancer: A Meta-analysis

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    Corresponding author: LIU Jiansheng, 147542533@qq.com (ORCID: 0000-0002-6038-2560)
  • 摘要:   目的  系统评价不可逆电穿孔(IRE)联合免疫治疗对于不可切除胰腺癌患者的安全性和有效性。  方法  本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024531984。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方和维普等数据库从建库至2024年2月发表的关于IRE联合免疫治疗不可切除胰腺癌的相关文献。按照设定的纳入和排除标准筛选文献并提取数据,评估文献质量。采用Review Manager 5.3和Stata 17.0软件进行Meta分析。  结果  最终纳入6篇研究,其中3篇前瞻性研究,2篇回顾性研究,1篇随机对照试验。共计376例不可切除胰腺癌患者,其中IRE治疗组222例,IRE联合免疫治疗组154例。Meta分析结果显示,IRE联合免疫治疗相较于IRE治疗组,能够明显提高患者的无进展生存期(HR=0.82,95%CI:0.72~0.92,P=0.001),延长总生存期(HR=0.86,95%CI:0.80~0.93,P=0.000 1),以及增加患者体内T淋巴细胞计数(MD=217.93,95%CI:192.87~242.99,P<0.000 01),提高患者机体免疫功能。但是在降低患者不良事件发生率(OR=1.43,95%CI:0.76~2.72,P=0.27)及提高患者疾病客观缓解率(OR=1.49,95%CI:0.87~2.56,P=0.15)方面差异均无统计学意义。  结论  IRE联合免疫治疗安全有效,可以明显提高不可切除胰腺癌患者总生存期与无进展生存期,增强患者免疫功能。

     

  • 图  1  文献筛选流程图

    Figure  1.  Flow chart of literature screening

    图  2  两组患者OS的Meta分析结果

    Figure  2.  Meta analysis results of OS in two groups

    图  3  两组患者PFS的Meta分析结果

    Figure  3.  Meta analysis of PFS in two groups

    图  4  两组患者ORR的Meta分析结果

    Figure  4.  Meta analysis results of orr in two groups of patients

    图  5  两组患者T淋巴细胞计数的Meta分析结果

    Figure  5.  Meta analysis results of T lymphocyte count in two groups of patients

    图  6  两组患者不良事件发生率的Meta分析结果

    Figure  6.  Meta analysis of the incidence of adverse events in the two groups

    表  1  纳入研究的6篇文献基本特征

    Table  1.   Basic characteristics of the six included studies

    作者 发表时间(年) 国家 例数 治疗方案 质量评分(分) 研究类型
    Lin12 2017 中国 71 IRE+NK细胞 NOS评分:7 前瞻性研究
    Lin13 2017 中国 40 IRE+NK细胞 NOS评分:7 前瞻性研究
    Lin14 2020 中国 62 IRE+γδ2 T淋巴细胞 Jadad评分:4 随机对照试验
    Pan15 2020 中国 92 IRE+NK细胞 NOS评分:8 前瞻性研究
    He16 2021 中国 85 IRE+toripalimab NOS评分:7 回顾性研究
    Zhang17 2023 中国 26 IRE+PD-1抑制剂 NOS评分:8 回顾性研究
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  • 收稿日期:  2024-03-07
  • 录用日期:  2024-04-16
  • 出版日期:  2024-11-25
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