基线甲状腺抗体对恶性肿瘤免疫检查点抑制剂治疗后出现甲状腺不良事件预测价值的meta分析  

Meta-analysis of the predictive value of baseline thyroid antibody for thyroid adverse events following immune checkpoint inhibitor treatment in malignant tumors

作　　者：明慧 余辉[1] 周蔷 陈援浩 Ming Hui;Yu Hui;Zhou Qiang;Chen Yuanhao(Department of Nuclear Medicine,Huangshi Central Hospital,Affiliated Hospital of Hubei Polytechnic University,Huangshi 435000,China;Department of Oncology,Huangshi Central Hospital,Affiliated Hospital of Hubei Polytechnic University,Huangshi 435000,China)

机构地区：[1]黄石市中心医院(湖北理工学院附属医院)核医学科,435000 [2]黄石市中心医院(湖北理工学院附属医院)肿瘤科,435000

出　　处：《中华内分泌代谢杂志》2024年第10期851-857,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：湖北理工学院校级科研项目(23xjz03Q)资助。

摘　　要：目的用meta分析评价基线甲状腺抗体对恶性肿瘤免疫检查点抑制剂治疗后出现甲状腺不良事件的预测价值。方法检索PubMed、Embase、Cochrane Library、中国知网(CNKI)及万方数据库中关于恶性肿瘤免疫检查点抑制剂(ICIs)治疗后的甲状腺相关不良反应研究。根据纳入与排除标准筛选文献,提取研究数据,采用RevMan 5.4和Stata 12.0软件进行meta分析。结果共纳入10篇恶性肿瘤ICIs治疗的文献,包含患者1480例,其中基线甲状腺抗体[甲状腺过氧化物酶抗体(TPOAb)或甲状腺球蛋白抗体(TgAb)]阳性251例,ICIs治疗后出现甲状腺免疫相关不良事件(irAEs)270例。Meta分析显示,基线甲状腺抗体阳性预测恶性肿瘤ICIs治疗后出现甲状腺irAEs的合并灵敏度为0.45(95%CI 0.35~0.56),合并特异度为0.95(95%CI 0.91~0.98),合并阳性似然比为4.04(95%CI 3.01~5.42),合并阴性似然比为0.57(95%CI 0.48~0.68),合并诊断比值比为16.31(95%CI 9.76~27.24)。综合受试者工作特征曲线下面积为0.80(95%CI 0.76~0.83)。Meta回归显示,研究地区、肿瘤类型的不同会导致异质性,具有统计学意义。结论基线甲状腺抗体(TPOAb和TgAb)对恶性肿瘤ICIs治疗后出现甲状腺irAEs的预测性能较高,具有较高的特异性,有利于早期预测甲状腺irAEs,并降低因漏诊甲状腺功能异常引起的不良风险,具有重要的临床价值。ObjectiveTo evaluate the predictive value of baseline thyroid antibodies for thyroid adverse events following treatment with immune checkpoint inhibitors(ICIs)in malignant tumors using meta-analysis.MethodsStudies on the thyroid related adverse reactions following immune checkpoint inhibitor therapy for malignant tumors in PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang databases were searched.Literature was screened based on inclusion and exclusion criteria,study data were extracted,and meta-analysis was conducted using the RevMan 5.4 and Stata 12.0.ResultsA total of 10 articles on ICIs therapy for malignant tumors were included,encompassing 1480 patients,of whom 251 had positive baseline thyroid antibodies(TPOAb or TgAb).After ICIs therapy,270 cases developed thyroid immune related adverse events(irAEs).Meta analysis showed that positive baseline thyroid antibodies predicted thyroid irAEs,with a pooled sensitivity of 0.45(95%CI 0.35-0.56),pooled specificity of 0.95(95%CI 0.91-0.98),pooled positive likelihood ratio of 4.04(95%CI 3.01-5.42),pooled negative likelihood ratio of 0.57(95%CI 0.48-0.68),and pooled diagnostic odds ratio of 16.31(95%CI 9.76-27.24).The area under the summary receiver operating characteristics was 0.80(95%CI 0.76-0.83).Meta regression showed that differences in regions and tumor types led to heterogeneity.ConclusionBaseline thyroid antibodies(TPOAb and TgAb)have high predictive performance and specificity for thyroid irAEs after ICIs treatment of malignant tumors.This facilitates early prediction of thyroid irAEs,reduces the risk of adverse outcomes due to undiagnosed thyroid dysfunction,and holds important clinical value.

关 键 词：免疫检查点抑制剂 程序性细胞死亡蛋白-1 程序性细胞死亡蛋白配体1 细胞毒性T淋巴细胞相关蛋白-4 甲状腺抗体 甲状腺相关不良反应 

分 类 号：R730.5[医药卫生—肿瘤]