ABSTRACT
OBJECTIVE To evaluate the efficacy and safety of PD-1/PD-L1 inhibitors for neoadjuvant treatment of bladder cancer， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， Cochrane Library， Embase， American Society of Clinical Oncology Meeting Library， CNKI， VIP and Wanfang database， etc.， the randomized controlled trials （RCTs）， non-RCT， case-control studies， cohort studies， etc. about PD-1/PD-L1 inhibitors for neoadjuvant treatment of bladder cancer were collected from the inception to Jan 31st， 2023. After literature screening， data extraction and quality evaluation， RevMan 5.3 software was used to perform meta-analysis of single-group rates； sensitivity analysis and publication bias analysis were conducted using Stata12 software. RESULTS A total of 25 studies were included in this discussion， involving 940 patients. The results of meta-analysis showed that the pathologic complete response （pCR） rate was 32% [OR＝0.32， 95%CI （0.22， 0.45）， P＝0.006]， downstaging rate was 52% [OR＝0.52， 95%CI （0.45， 0.60）， P＝0.55]， and the incidence of ≥grade 3 immune-related adverse events （irAEs） was 16% [OR＝0.16， 95%CI （0.11， 0.22）， P＜0.000 01]. Subgroup analysis showed that the patients receiving PD-1/PD-L1 inhibitors alone had a pCR rate of 25% and a incidence of Grade≥3 irAEs of 9%； the patients receiving combined immunotherapy had a pCR rate of 29% and a incidence of Grade≥3 irAEs of 28%； the patients receiving PD-1/PD-L1 inhibitors combined with chemotherapy had a pCR rate of 43% and a incidence of Grade≥3 irAEs of 12%； PD-L1 positive patients had a pCR rate of 44%， and PD-L1 negative patients had a pCR rate of 25%. The results of the sensitivity analysis showed that the study was robust. The results of the publication bias analysis showed that there was no significant publication bias. CONCLUSIONS PD-1/PD-L1 inhibitors are effective and safe for adjuvant treatment of bladder cancer.
ABSTRACT
s Objective: The characteristics of locoregional rectal cancer recurrences following total mesorectal excision (TME) were not clear previously. This study aimed to analyze and help determine the optimal radiotherapy clinical target volume. Methods: The clini-cal data of 134 patients who had recurrence and metastasis following TME without radiotherapy between January 2012 and Novem-ber 2018 in our hospital were retrospectively analyzed. The Chi-square test was used to evaluate the relationship between lymph node metastasis and clinicopathological factors, such as the location of primary tumors and tumor stage. The correlations between different types of lymphatic drainage of rectal cancer were also tested. Results: In total, 134 patients were enrolled in this study. The median time to relapse was 15 months. The incidences of anastomotic, rectal and mesorectal, pelvic presacral space, abdominal presacral space, internal iliac node, external iliac node, obturator node, inguinal node, and ischiorectal fossa recurrences were 42.5% (57/134), 26.9% (36/134), 25.4% (34/134), 7.5% (10/134), 34.3% (46/134), 3.7% (5/134), 0.7% (1/134), 9.7% (13/134), and 8.2% (11/134), re-spectively. Compared with mid-lower rectal cancer, upper rectal cancer was more prone to metastasis in the abdominal presacral space (19.0% vs. 5.6%, P=0.028). Patients with inguinal lymph node metastasis were more likely to harbor external iliac node metasta-sis (23.1% vs. 1.7%, P=0.006). Conclusions: There is a great difference in the recurrence patterns between upper and mid-lower rectal cancer. As a result, the clinical target volumes of radiation therapy for upper and mid-lower rectal cancer should be defined separately. Optimizing the clinical target volume of radiotherapy will be of great value in the future.