Objective To systematically review the sex differences in efficacy of immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) patients. Methods We conducted a computer search of Medline, The Cochrane Library, and EMbase from inception to November 2022 to collect randomized controlled trials (RCTs) that assessed the efficacy of ICIs for NSCLC patients. Meta-analysis was performed using RevMan 5.4 software. Results Finally 16 RCTs with a total of 9 653 patients were included, and all were evaluated as high-quality literature using the modified Jadad scale. Meta-analysis results showed that in female NSCLC patients receiving immune therapy, the median overall survival (OS) [HR=0.72, 95%CI(0.61, 0.85), P<0.001] was longer than in males [HR=0.73, 95%CI(0.69, 0.78), P=0.401]. Males [HR=0.64, 95%CI(0.58, 0.71), P=0.171] had an advantage over females [HR=0.76, 95%CI(0.57, 1.03), P<0.001] in median progression-free survival (PFS). Conclusion Females receiving ICIs have immunotherapeutic advantages in terms of median OS compared to males, while males are more likely to benefit statistically in terms of median PFS than females.
Objective To systematically review the efficacy and safety of immune checkpoint inhibitors (ICIs) as first-line treatment for advanced non-small cell lung cancer (NSCLC). MethodsTo collect clinical randomized controlled trials of ICIs for the first-line treatment of patients with NSCLC, computer searches were conducted on PubMed, The Cochrane Library, and EMbase databases. The search time frame was inception to January 2023. A meta-analysis was performed using Revman 5.4 software. ResultsTwelve clinical studies were included, all of which were assessed as high-quality literature with a total of 7 121 patients. Meta-analysis showed that the first-line treatment of NSCLC patients with ICIs significantly improved median overall survival (OS) (HR=0.72, 95%CI 0.64 to 0.80, P < 0.000 01), prolonged median progression-free survival (PFS) (HR=0.65, 95%CI 0.53 to 0.78, P<0.000 01), and improved objective response rate (ORR) (RR=1.52, 95%CI 1.28 to 1.79, P<0.000 01), compared to chemotherapy. Subgroup analysis showed that the ICIs combination therapy group significantly improved OS, PFS, and ORR in NSCLC patients compared to the ICIs monotherapy group. In terms of safety, the ICIs group had a lower risk of treatment-related adverse events (TRAEs) of any grade and grade 3-5 TRAEs than the chemotherapy group. However, the ICIs group had a higher incidence of TRAEs leading to treatment cessation than the chemotherapy group. Subgroup analysis showed that the incidence of any grade TRAEs, grade 3-5 TRAEs, leading to treatment discontinuation TRAEs was higher in the immune combination therapy group than in the immune monotherapy group. ConclusionThe first-line treatment of NSCLC patients with ICIs inhibitors significantly improved OS, PFS, and ORR compared to chemotherapy. Immune-combination chemotherapy significantly improved the outcomes of NSCLC patients, compared to immune monotherapy, but patients were at a higher risk of TRAEs.
Objective To systematically evaluate the efficacy and safety of Single-incision thoracoscopic surgery (SITS) and two-port video-assisted thoracoscopic surgery (2P-VATS) in the treatment of spontaneous pneumothorax. Methods The databases of CNKI, PubMed, The Cochrane Libray, Web of Science, EMbase, Wanfang and Chinese Medical Association were searched by computer. Literature on SITS treatment of spontaneous pneumothorax from the establishment of the database to March 2023. The data are processed with RevMan 5.4.1. Results Finally, 107 studies were included, including 35 RCTs, 2 cohort studies, and 70 case-control studies. Meta analysis results show that compared to 2P-VATS and three port video assisted thoracoscopic surgery (3P-VATS), SITS had a shorter surgical time [SMD=–0.53, 95%CI (–0.90, –0.16), P=0.005], less intraoperative bleeding [SMD=–1.58, 95%CI (–1.93, –1.22), P<0.000 01; SMD=–1.59, 95%CI (–2.03,–1.14), P<0.000 01], shorter postoperative hospitalization time [SMD=–1.05, 95%CI (–1.29,–0.82), P<0.000 01; SMD=–1.08, 95%CI (–1.39,–0.77), P<0.000 01], and shorter postoperative drainage (catheterization) time [SMD=–0.75, 95%CI (–1.00,–0.50), P<0.000 01; SMD=–1.23, 95%CI (–1.72,–0.75), P<0.000 01], fewer postoperative complications [OR=0.34, 95%CI (0.26,0.45), P<0.000 01; OR=0.47, 95%CI (0.33,0.68), P<0.000 1], fewer postoperative recurrences [OR=0.50, 95%CI (0.33,0.75), P=0.000 8], and lighter postoperative pain [SMD=–1.71, 95%CI (–1.98,–1.45), P<0.000 01; SMD=–2.02, 95%CI (–2.46,–1.59), P<0.000 01]. Compared with 3P-VATS, 2P-VATS had less intraoperative bleeding [SMD=–1.02, 95%CI (–1.81,–0.22), P=0.01] , shorter postoperative hospitalization time [SMD=–0.59, 95%CI (–1.11,–0.06), P=0.03], shorter postoperative drainage (catheterization) time [SMD=–0.46, 95%CI (–0.85,–0.08), P=0.02], fewer postoperative complications [OR=0.36, 95%CI (0.22,0.59), P<0.000 1] , and lighter postoperative pain [SMD=–0.80, 95%CI (–1.08,–0.53), P<0.000 01]. Conclusion SITS and 2P-VATS are an effective and safe method for the treatment of spontaneous pneumothorax and worthy of further promotion and application in clinical practice. Due to limitations in the quantity and quality of included studies, the above conclusions require more large-sample, high-quality studies to be verified.
ObjectiveTo systematically evaluate the efficacy of immune checkpoint inhibitors (ICIs) in treating esophageal cancer patients of different genders. MethodsComputer searches were conducted on PubMed, The Cochrane Library, and EMbase databases to collect randomized controlled trial (RCT) on ICIs treatment for esophageal cancer patients from the establishment of the databases to January 25, 2024. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The outcome indicators were overall survival (OS) and progression-free survival (PFS), and RevMan 5.4 software was used for meta-analysis. The modified Jadad scoring scale was used to evaluate the quality of the included literature. ResultsA total of 10 RCT involving 5364 esophageal cancer patients were included in this study, with 2684 patients in the experimental group and 2680 patients in the control group. The Jadad scores of the included literature were all ≥6 points, indicating high-quality RCT. Meta-analysis results showed that female esophageal cancer patients receiving ICIs treatment [HR=0.72, 95%CI (0.59, 0.87), P<0.001] had a more significant median OS prolongation than male patients [HR=0.73, 95%CI (0.68, 0.78), P<0.001]; while male patients [HR=0.57, 95%CI (0.52, 0.64), P<0.001] had a more significant PFS prolongation than female patients [HR=0.72, 95%CI (0.55, 0.94), P=0.01]. Female patients treated with ICIs alone [HR=0.66, 95%CI (0.50, 0.87), P=0.003] had a more significant median OS prolongation than male patients [HR=0.79, 95%CI (0.72, 0.87), P<0.001]; while male patients receiving ICIs combined with chemotherapy [HR=0.67, 95%CI (0.61, 0.74), P<0.001] had a more significant median OS prolongation than female patients [HR=0.77, 95%CI (0.59, 1.01), P=0.06]. ConclusionFemale patients receiving ICIs have a slight advantage in OS compared to male patients, while male patients have an advantage in PFS. Male patients receiving ICIs combined with chemotherapy have better survival benefits than female patients, while female patients using ICIs monotherapy have better survival benefits than male patients.