Impact of bone metastasis on prognosis in non-small cell lung cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

作者：Yonghua Zhu, Jingyao She, Rong Sun, Xinxin Yan, Xinyao Huang, Peijuan Wang, Bo Li, Xiangdong Sun, Changqing Wang, Kai Jiang · 发表于：Frontiers in Immunology · 年份：2024 · DOI：10.3389/fimmu.2024.1493773 · 被引用次数：21 · 研究领域：Bone health and treatments、Management of metastatic bone disease、Cancer Immunotherapy and Biomarkers

Background: Lung cancer is a leading cause of cancer-related deaths globally, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. While immune checkpoint inhibitors (ICIs) have transformed treatment for advanced NSCLC, the role of bone metastasis in modulating ICI efficacy remains unclear. Bone metastasis, occurring in 30-40% of advanced NSCLC cases, is associated with worse outcomes. However, how this affects the therapeutic benefit of ICIs has not been fully elucidated, highlighting a critical knowledge gap in optimizing treatment for this patient population. Methods: A comprehensive literature search across multiple databases, including PubMed, Embase, and Cochrane, identified 13 studies with a total of 3,681 patients, of whom 37.6% had bone metastasis. Overall survival (OS) and progression-free survival (PFS) were compared between NSCLC patients with and without bone metastasis. Data were analyzed using a random-effects model to account for study heterogeneity. Results: The meta-analysis demonstrated that bone metastasis significantly worsened overall survival (OS) and progression-free survival (PFS) in NSCLC patients treated with ICIs. Specifically, bone metastasis was associated with a 45% increased risk of death (HR: 1.45, 95% CI: 1.30-1.62, p < 0.001) and a 40% increased risk of disease progression (HR: 1.40, 95% CI: 1.25-1.58, p < 0.001). No statistically significant impact on PFS was observed. (HR: 1.28, 95% CI: 0.77-2.10, p = 0.34). H...