针对局部dMMR/MSI-H胃癌的新辅助免疫检查点抑制剂:一个元分析
W K Schwengber1, R A Pereira2, L F Leite da Silva3
1Internal Medicine Division, Mayo Clinic, Phoenix, USA.
ESMO open
|February 13, 2026
概括
新辅助性免疫检查点抑制剂 (ICI) 对缺陷不匹配修复 (dMMR) 和微卫星不稳定性高 (MSI-H) 的胃癌具有前景. 较长的治疗持续时间可能会改善病理完整反应 (pCR) 率,支持进一步研究非手术治疗.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 免疫治疗是一种免疫疗法.
背景情况:
- 局部缺陷不匹配修复 (dMMR) 和微卫星不稳定性高 (MSI-H) 的胃和胃食道结 (GEJ) 癌症显示新辅助免疫检查点抑制剂 (ICI) 的瘤回归有希望.
- 现有的数据主要来自小型非随机研究,因此需要对疗效和安全结果进行全面综合.
研究的目的:
- 系统地评估新辅助药ICI在局部dMMR/MSI-H胃癌和GEJ癌症中的疗效和安全性.
- 为了描述与非手术管理 (NOM) 相关的结果,在这个患者队列中.
主要方法:
- 在主要数据库 (PubMed,EMBASE,Scopus,Web of Science,Cochrane Reviews) 进行了系统的文献搜索,截至2025年6月.
- 数据提取和质量评估由两名独立审查员根据PRISMA指南进行.
- 为有效性终点和NOM结果的定性总结生成了聚合估计.
主要成果:
- 包括20项涉及396名患者的研究,其中大多数接受ICI单疗或联合疗法.
- 综合病理完整响应 (pCR) 率为41.9%,临床完整响应为63.8%.
- 治疗持续时间≥3个月与明显更高的pCR率 (50.2%) 相比<3个月 (28.4%) 相关. 3-4级免疫相关不良事件发生在6.7%的患者中.
结论:
- 新辅助剂ICI在局部dMMR/MSI-H胃癌和GEJ癌症中显示出良好的疗效和安全性.
- 延长的新辅助性ICI治疗 (≥3个月) 可能会提高pCR率.
- 进一步的前性研究对于优化治疗持续时间和确定器官保存策略的作用至关重要,如NOM.
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