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Meta-Analysis
. 2022 Dec 29;22(1):490.
doi: 10.1186/s12890-022-02292-5.

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

Wei Liu  1   2 , Tiantian Zhang  1   2 , Qian Zhang  1   2 , Li Li  1   2 , Chunhua Xu  3   4
Affiliations
Meta-Analysis

A systematic review and meta-analysis of neoadjuvant chemoimmunotherapy in stage III non-small cell lung cancer

Wei Liu et al. BMC Pulm Med. .

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.

Keywords: Neoadjuvant chemoimmunotherapy; Non-small cell lung cancer; Safety and efficacy; Stage III.

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Conflict of interest statement

The authors declare that there are no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA flowchart: the selection process for the eligible studies
Fig. 2
Fig. 2
Forest plots of the radiological and pathological response outcomes. A The pooled prevalence of MPR; B the pooled pCR rate; C the pooled prevalence of radiological response outcomes; D the occurrence of R0 resection;
Fig. 3
Fig. 3
Forest plots of the safety of surgery. A The pooled TRAEs rate; B the SAE rate
Fig. 4
Fig. 4
Forest plots of the feasibility. A The pooled incidence of surgical resection; B the pooled conversion to thoracotomy rate; C the rate of surgical complications; D the tumor downstaging rate
See this image and copyright information in PMC

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