Brain Metastases Status and Immunotherapy Efficacy in Advanced Lung Cancer: A Systematic Review and Meta-Analysis.

Background: Brain metastases (BMs) indicate poor outcomes and are commonly excluded in immunotherapy clinical trials in advanced lung cancer; moreover, the effect of BM status on immunotherapy efficacy is inconsistent and inconclusive. Therefore, we conducted a meta-analysis to assess the influence of BM status on immunotherapy efficacy in advanced lung cancer. Methods: Electronic databases and all major conference proceedings were searched without language restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We extracted randomized clinical trials on lung cancer immunotherapy that had available overall survival (OS) and/or progression-free survival (PFS) data based on the BM status. All analyses were performed using random effects models. Results: Fourteen randomized clinical trials with 9,089 patients were identified. Immunotherapy conferred a survival advantage to BM patients [OS-hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.58-0.90; P = 0.004; and PFS-HR, 0.68; 95% CI, 0.52-0.87, P = 0.003]. Non-BM patients could also derive a survival benefit from immunotherapy (OS-HR, 0.76; 95% CI, 0.71-0.80; P <0.001; and PFS-HR, 0.68; 95% CI, 0.56-0.82, P <0.001). The pooled ratios of OS-HRs and PFS-HRs reported in BM patients versus non-BM patients were 0.96 (95% CI, 0.78-1.18; P = 0.72) and 0.97 (95% CI, 0.79-1.20; P = 0.78), respectively, indicating no statistically significant difference between them. Subsequent sensitivity analyses did not alter the results. Subgroup analyses according to tumor type, line of therapy, immunotherapy type, study design, and representation of BM patients reconfirmed these findings. Conclusion: We demonstrated that BM status did not significantly influence the immunotherapy efficacy in lung cancer, suggesting that both BM and non-BM patients could obtain comparable benefits. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier (CRD42020207446).

Association of menopausal status with COVID-19 outcomes: a propensity score matching analysis.

BACKGROUND: Despite the growing number of studies on the coronavirus disease-19 (COVID-19), little is known about the association of menopausal status with COVID-19 outcomes. MATERIALS AND METHODS: In this retrospective study, we included 336 COVID-19 inpatients between February 15, 2020 and April 30, 2020 at the Taikang Tongji Hospital (Wuhan), China. Electronic medical records including patient demographics, laboratory results, and chest computed tomography (CT) images were reviewed. RESULTS: In total, 300 patients with complete clinical outcomes were included for analysis. The mean age was 65.3 years, and most patients were women (n = 167, 55.7%). Over 50% of patients presented with comorbidities, with hypertension (63.5%) being the most common comorbidity. After propensity score matching, results showed that men had significantly higher odds than premenopausal women for developing severe disease type (23.7% vs. 0%, OR 17.12, 95% CI 1.00-293.60; p = 0.003) and bilateral lung infiltration (86.1% vs. 64.7%, OR 3.39, 95% CI 1.08-10.64; p = 0.04), but not for mortality (2.0% vs. 0%, OR 0.88, 95% CI 0.04-19.12, p = 1.00). However, non-significant difference was observed among men and postmenopausal women in the percentage of severe disease type (32.7% vs. 41.7%, OR 0.68, 95% CI 0.37-1.24, p = 0.21), bilateral lung infiltration (86.1% vs. 91.7%, OR 0.56, 95% CI 0.22-1.47, p = 0.24), and mortality (2.0% vs. 6.0%, OR 0.32, 95% CI 0.06-1.69, p = 0.25). CONCLUSIONS: Men had higher disease severity than premenopausal women, while the differences disappeared between postmenopausal women and men. These findings support aggressive treatment for the poor prognosis of postmenopausal women in clinical practice.

Predictive value of excision repair cross-complementation group 1 protein in locoregionally advanced nasopharyngeal carcinomas receiving cisplatin-based concurrent chemoradiotherapy.

OBJECTIVE: To investigate the ability of excision repair cross-complementation group 1 (ERCC1) protein to predict cisplatin-based concurrent chemoradiotherapy (CCRT) response in locoregionally advanced nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: The clinical data of 205 patients with locoregionally advanced NPC, who received cisplatin-based CCRT, were analyzed retrospectively. Immunohistochemical analysis was used to assess the ERCC1 expression in nasopharyngeal tumor tissues. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate Cox proportional hazards analyses were performed to evaluate the association between ERCC1 expression and failure-free survival (FFS), overall survival (OS), locoregional-FFS (L-FFS), and distant-FFS (D-FFS). RESULTS: Our results revealed that although the overall response rate in patients with high-ERCC1 expression (97.3%) and those with low-ERCC1 expression (100.0%) were not statistically different, but treatment-sensitive group displayed significantly lower ERCC1 expression in comparison to the treatment-resistant group (P = 0.001). The Kaplan-Meier plots revealed that the low-ERCC1 expression was significantly associated with better L-FFS, FFS, and OS of locally advanced NPC patients receiving cisplatin-based CCRT. Both univariate and multivariate analysis demonstrated that the ERCC1 expression, tumor node metastasis stage and performance status were independent predictors of OS and FFS. CONCLUSION: ERCC1 expression may be a useful predictive marker in patients with locoregionally advanced NPC, who are receiving cisplatin-based CCRT.

[Analysis of responses and prognostic factors in different chemotherapy regimens for metastatic nasopharyngeal carcinoma: a report of 171 cases].

OBJECTIVE: The aim of this study was to compare the results of different combined chemotherapy regimens and to find the best regimen for metastatic nasopharyngeal carcinoma (NPC), and determine its prognostic factors. METHODS: The clinical data of 171 patients with pathologically proven metastatic NPC were retrospectively analyzed. Of them, 26 were treated with best support care (BSC group), 92 with platinum-based regimen of two drugs (FP group: 5-Fu and cisplatin; TP group: paclitaxel and cisplatin; DP group: docetaxel and cisplatin), and 53 with platinum-based regimen of three-drugs (TFP group: FP plus paclitaxel, DFP group: FP plus doxtale). RESULTS: The response rate (RR) in the three-drug regimens was significantly higher than that in the two-drug regimen (84.9% vs. 52.2%, P = 0.000), however, grade III approximately IV myelosuppression in the three-drug regimen group was also significantly higher than that in the two-drug regimen (58.5% vs. 27.2%, P = 0.000). Among the groups treated with platinum-based combination regimens of either two drugs or three drugs, no significant differences were observed in RR (P = 0.967, P = 0.400) or median survival time (MST) (P = 0.278, P = 0.413). The MST and one-year survival rate were 4.0 months, 13.2 months and 15.0 months, 24.0%, 64.1% and 70.3% in the BSC group, two-drug group and three-drug group, respectively. The MST in the chemotherapy group was significantly longer than that in BSC group (P = 0.000). Cox multivariate regression analysis showed that Karnovsky performance scores, time to progression or chemotherapy cycles were independent prognostic factors (P < 0.05). CONCLUSION: Chemotherapy can improve the survival of metastatic NPC. Platinum-based combination regimen with two drugs is still the standard treatment. The combination regimens with three drugs can increase the RR, but no survival benefit can be achieved for its high toxicity.