ABSTRACT
Objective:To evaluate the efficacy and safety of programmed death 1 (PD-1), programmed death ligand 1 (PD-L1) immune checkpoint inhibitor (ICI) monotherapy for brain metastasis in advanced non-small cell lung cancer (NSCLC), and to explore the timing of immunomonotherapy and the application of hormone on the efficacy of ICI.Methods:By searching literature in CNKI, Wanfang, VIP, PubMed, CBM, Embase, Cochrane Library and Web of Science databases, the advanced NSCLC patients with brain metastasis who received ICI treatment were identified, including patients with symptomatic brain metastasis who had received hormone therapy or brain surgery or radiotherapy. Meta-analysis was performed on the collected data to evaluate the systemic objective response rate (sORR) and intracerebral tumor objective response rate (iORR), the iORR of whether ICI monotherapy was first-line therapy, and the iORR of whether hormone was used were evaluated, and the incidence of adverse reactions was evaluated.Results:Fifteen studies were finally included, with a total of 4 033 patients, including 917 patients with brain metastasis. The iORR of immunomonotherapy was 26% (95% CI 19%-34%) and the sORR was 28% (95% CI 18%-40%). The iORR of first-line immunomonotherapy was 49% (95% CI 39%-58%). The iORR of symptomatic patients with hormone therapy and asymptomatic patients without hormone therapy was 26% (95% CI 20%-33%) and 19% (95% CI 16%-22%), respectively. The overall incidence of grade 3-4 adverse reactions was 14% (95% CI 11%-17%). Conclusions:The efficacy of ICI monotherapy in the first-line treatment of PD-L1-positive NSCLC patients with brain metastasis is better than that in the subsequent line therapy, and the application of hormone does not affect the efficacy of ICI. ICI monotherapy in the treatment of advanced NSCLC patients with brain metastasis is safe.
ABSTRACT
Objective To investigate the prevalence of occupational asthma,airway inflammation and analyze the risk factors for workers exposed to isocyanates.Methods A cross-sectional study was applied.Totally 429 isocyanates exposed workers were surveyed and the prevalence of occupational asthma and airway inflammation situation were examined by questionnaire,physical examination and laboratory tests.Multivariate logistic regression was applied to analyze the possible risk factors of isocyanate-induced occupational asthma.Results (1) A total of 366 patients with complete data were included in the study,and finally 11 cases were diagnosed as isocyanate-induced occupational asthma with a prevalence of 3.0％.(2) Neutrophil percentage in the induced sputum of occupational asthma increased significantly [42.00％ (34.00％-55.00％) before work and 59.00％ (51.00％-70.00％) after work (Z =-2.940.P ＜ 0.05)].(3) Length of service (OR =3.096,P =0.025) and rhinitis (OR =1.901,P =0.008) were independent dangerous factors,and protective measures (OR =0.074,P =0.015) was protective factors to isocyanateinduced occupational asthma.Conclusions Neutrophilic inflammation can be triggered by isocyanate exposure.Regular health examinations,effective protective measures can reduce the prevalence of isocyanateinduced occupational asthma.