免疫检查点抑制剂治疗后甲状腺功能障碍的发生率和风险评估:系统性审查和元分析
Liying Wang1,2, Yanjie Han3, Tianchen Wu4
1School of Elderly Care Services and Management, Nanjing University of Chinese Medicine Nanjing 210001, Jiangsu, China.
免疫检查点抑制剂 (ICI) 可以导致甲状腺功能障碍. 甲状腺功能障碍症比甲状腺功能障碍症更常见,并结合ICI疗法增加这种风险.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 免疫治疗是一种免疫疗法.
背景情况:
- 免疫检查点抑制剂 (ICI) 改善了癌症治疗结果.
- 然而,ICI与免疫相关的不良事件有关,包括甲状腺功能障碍 (ICI-TD).
- 了解ICI-TD的发生率和模式对于患者管理至关重要.
研究的目的:
- 在接受ICI治疗的患者中评估甲状腺功能障碍的风险.
- 为了比较与ICI相关的甲状腺功能障碍和甲状腺功能障碍的发病率.
- 评估ICI综合疗法对ICI-TD风险的影响.
主要方法:
- 在PubMed,Embase和Cochrane图书馆进行系统的文献搜索,以寻找ICI在恶性瘤中的II/III期随机对照试验.
- 使用Stata (版本17) 的统计分析.
- 使用审查经理 (版本5.4) 进行偏差风险评估.
主要成果:
- 纳入了40个与12,376名患者的RCT.
- 甲状腺功能障碍 (RR = 9.91) 的发生率比甲状腺功能障碍 (RR = 7.70) 的发生率更高.
- 组合ICI疗法显示ICI-TD的发病率高于单疗法,特定组合 (PD-L1/CTLA-4,PD-1/CTLA-4) 分别为低甲状腺症和甲状腺功能障碍的最高风险.
结论:
- 与ICI相关的甲状腺功能障碍比甲状腺功能障碍症更频繁.
- 组合ICI疗法显著增加了ICI-TD的发生率.
- 需要进一步研究ICI-TD在组合治疗患者的管理.
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