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  

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

作　　者：叶舰 杨峻峰 杜丽文 刘建生[2] YE Jian;YANG Junfeng;DU Liwen;LIU Jiansheng(The First Clinical Medical College of Shanxi Medical University,Taiyuan 030000,China;Department of Hepatobiliary and Pancreatic Surgery,The First Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西医科大学第一医院肝胆胰外科,太原030001

出　　处：《临床肝胆病杂志》2024年第11期2277-2282,共6页Journal of Clinical Hepatology

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Pub Med、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=0.0001),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<0.00001),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。Objective To systematically review the safety and efficacy of irreversible electroporation(IRE)combined with immunotherapy in patients with unresectable pancreatic cancer.Methods This study was conducted according to the PRISMA guideline,with a PROSPERO registration unmber of CRD42024531984.Datebases including PubMed,Embase the Cochrane Library,Web of Science,CNKI,Wanfang Data,and VIP were searched for related articles on IRE combined with immunotherapy for unresectable pancreatic cancer published up to February 2024.The articles were screened and related data were extracted according to the established inclusion and exclusion criteria,and the quality of the articles was assessed.Review Manager 5.3 and Stata 17.0 software were used to perform the meta-analysis.Results Six studies were finally included,with three prospective studies,two retrospective studies,and one randomized controlled trial.There were 376 patients with unresectable pancreatic cancer in total,among whom there were 222 patients in the IRE group and 154 patients in the IRE+immunotherapy group.The metaanalysis showed that compared with IRE alone,IRE combined with immunotherapy significantly prolonged progression-free survival(hazard ratio[HR]=0.82,95%confidence interval[CI]:0.72-0.92,P=0.001)and overall survival(HR=0.86,95%CI:0.80—0.93,P=0.0001),increased T lymphocyte count in the patients(mean difference=217.93,95%CI:192.87-242.99,P<0.00001),and improved the immune function of patients.However,there were no significant differences between the two groups in reducing the incidence rate of adverse events(odds ratio[OR]=1.43,95%CI:0.76-2.72,P=0.27)and improving the objective remission rate of patients(OR=1.49,95%CI:0.87-2.56,P=0.15).Conclusion IRE combined with immunotherapy is safe and effective in patients with unresectable pancreatic cancer and can significantly improve overall survival and progression-free survival and enhance immune function,with little effect on objective remission rate and the incidence rate of adverse events.

关 键 词：胰腺肿瘤 消融技术 免疫抑制法 META分析 

分 类 号：R735.9[医药卫生—肿瘤] G353.1[医药卫生—临床医学]