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PD-1/PD-L1 based immunochemotherapy vs chemotherapy alone for advanced esophageal squamous cell carcinoma: a meta-analysis focus on PD-L1 expression level
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  • Zixian Jin,
  • Jiping Wang,
  • Jiajing Sun,
  • Chengchu Zhu,
  • Jian Zhang,
  • Bo Zhang
Zixian Jin
Taizhou Hospital of Zhejiang Province

Corresponding Author:[email protected]

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Jiping Wang
Taizhou Hospital of Zhejiang Province
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Jiajing Sun
Taizhou Hospital of Zhejiang Province
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Chengchu Zhu
Taizhou Hospital of Zhejiang Province
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Jian Zhang
Taizhou Hospital of Zhejiang Province
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Bo Zhang
Taizhou Hospital of Zhejiang Province
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Abstract

Objective: Immunochemotherapy has become a new treatment for advanced esophageal squamous cell carcinoma (ESCC). We aimed to study the clinical efficacy and toxicity of immunochemotherapy based on PD-1/PD-L1 compared with chemotherapy alone in the treatment of advanced ESCC, focusing on analyzing the influence of PD-L1 expression level. Methods: Randomized controlled trials comparing PD-1/PD-L1 based immunochemotherapy wirh chemotherapy alone for advanced ESCC were included. We extracted efficacy data [objective response rate (ORR), disease control rate (DCR), overall survival (OS) rate, progression-free survival (PFS) rate] and safety data (treatment-related adverse events, treatment-related mortality) and performed meta-analyses. Results: 5 articles were included. Compared with chemotherapy alone, the ORR and DCR of immunochemotherapy increased by 2.05 times and 1.54 times, respectively. Overall, patients receiving immunochemotherapy had a significant long-term survival advantage [OS: hazard ratio (HR)=0.68, 95% hazard ratio (CI) 0.61-0.75; PFS: HR=0.62, 95%CI 0.55, 0.70, respectively]. Even with PD-L1 tumor proportion score <1%, immunochemotherapy also showed a significant survival advantage [OS: HR=0.65, 95%CI 0.46-0.93; PFS: HR=0.56, 95%CI 0.46-0.69, respectively]. However, for PD-L1 combined positive score (CPS)<1, the survival advantage of immunochemotherapy was not significant [OS: HR=0.89, 95%CI 0.42-1.90; PFS: HR=0.71, 95%CI 0.47-1.08, respectively]. The toxicity of immunochemotherapy was higher than that of chemotherapy alone, but there was no statistical difference in treatment-related mortality (odds ratio=1.11, 95%CI 0.67-1.83). Conclusions: In this study, PD-1/PD-L1 based immunochemotherapy significantly could improve survival outcomes in patients with advanced ESCC. For patients with CPS<1, the survival advantage of immunochemotherapy was not significant. The toxicity of immunochemotherapy was acceptable.
27 Oct 2022Submitted to Cancer Reports
28 Oct 2022Submission Checks Completed
28 Oct 2022Assigned to Editor
28 Oct 2022Review(s) Completed, Editorial Evaluation Pending
01 Nov 2022Reviewer(s) Assigned
21 Nov 2022Editorial Decision: Revise Major
18 Dec 20221st Revision Received
20 Dec 2022Assigned to Editor
20 Dec 2022Submission Checks Completed
20 Dec 2022Review(s) Completed, Editorial Evaluation Pending
20 Dec 2022Reviewer(s) Assigned
06 Jan 2023Editorial Decision: Revise Major
21 Jan 20232nd Revision Received
23 Jan 2023Submission Checks Completed
23 Jan 2023Assigned to Editor
23 Jan 2023Review(s) Completed, Editorial Evaluation Pending
23 Jan 2023Reviewer(s) Assigned
01 Feb 2023Editorial Decision: Accept