Continuing immune checkpoint inhibitors after pseudoprogression improves survival in lung cancer patients: a systematic review and meta-analysis

作者：Aiben Huang, Mei Xie, Chongchong Wu, Jie Gao, Xidong Ma, Hui Deng, Jialin Song, Jing Liu, Jie Yao, Xuwen Lin, Xin Zhang, Xinyu Bao, Yiming Liam Liu, Xuelei Zang, Fangping Ren, Li Pang, Jin Qian, Zhiqiang Xue, Lei Pan, Xinying Xue · 发表于：Journal of Thoracic Disease · 年份：2025 · DOI：10.21037/jtd-2025-1381 · 被引用次数：4 · 研究领域：Cancer Immunotherapy and Biomarkers、Lung Cancer Diagnosis and Treatment、Inflammatory Biomarkers in Disease Prognosis

Background: Pseudoprogression (PsP) in lung cancer patients receiving immune checkpoint inhibitors (ICIs) complicates treatment decisions. This study evaluated the prognostic impact of continuing versus discontinuing ICI post-PsP and developed tools for PsP identification via an individual patient data (IPD) pooled analysis. Methods: This IPD pooled analysis included 40 PsP cases (4 institutional cases + 36 literature-derived cases, who were categorized into continued-ICI and interrupted-ICI groups. Prognoses were compared using Fisher’s exact test (12-month survival) and Kaplan-Meier/log-rank tests (median overall survival). A chest computed tomography (CT) pattern diagram and proposed diagnostic-therapeutic framework were developed. Results: The median time to PsP onset was 8 weeks. Initially, 87.5% of cases were misclassified as progressive disease (PD) by Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1), whereas Immune-Related Response Evaluation Criteria in Solid Tumors (iRECIST) corrected such misclassifications. Continued ICI treatment was associated with significantly longer median overall survival (16.6 vs. 7.4 months, P<0.01) and a higher 12-month survival rate (66.7% vs. 40.0%, P<0.01). To improve clinical recognition, we developed a chest CT pattern diagram delineating characteristic PsP imaging features. Additionally, a proposed diagnostic-therapeutic framework was developed to guide management, but it remains hypothesis-generating and requires valid...