ICIs一线治疗晚期胃癌有效性及安全性的网状Meta分析OA

OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors(ICIs)as first-line therapy for advanced gastric cancer.METHODS PubMed,Web of Science,Embase,The Cochrane Library,Wanfang Data,CNKI,and VIP databases were searched to collect phase Ⅲ clinical randomized controlled trials(RCTs)on ICIs as first-line therapy for advanced gastric cancer,as well as abstracts from relevant oncology academic conferences.The search period spanned from database inception to June 1,2025.After screening literature,extracting data,and assessing quality,a network meta-analysis was performed using R software version 4.3.2.RESULTS A total of 8 studies involving 7 801 patients were included.Network meta-analysis results showed that,in terms of efficacy,compared with chemotherapy(Chemo),SHR-1701_Chemo,Cadonilimab_Chemo,Sintilimab_Chemo,Pembrolizumab_Chemo,and Tislelizumab_Chemo significantly prolonged median overall survival(OS)and median progression free survival(PFS)in patients(P＜0.05);whereas Nivolumab_Chemo only significantly improved median PFS(P＜0.05).Surface under the cumulative ranking curve(SUCRA)results indicated that the top 2 interventions for median OS were SHR-1701_Chemo and Cadonilimab_Chemo;for PFS,the top 2 were Cadonilimab_Chemo and SHR-1701_Chemo.For patients with combined positive score(CPS)≥5 points for programmed death-ligand 1(PD-L1),Cadonilimab_Chemo and SHR-1701_Chemo also demonstrated the optimal OS and PFS benefits(P＜0.05).Regarding safety,there were no statistically significant differences among the interventions in the incidence of any adverse events(AEs)or grade≥3 AEs(P＞0.05).The SUCRA ranking for the incidence of any AEs showed the top 2 were SHR-1701_Chemo and Chemo;for grade≥3 AEs,the top 2 were Chemo and Sugemalimab_Chemo.CONCLUSIONS For patients with advanced gastric cancer,Cadonilimab_Chemo and SHR-1701_Chemo demonstrate the best benefits in terms of OS and PFS,with their advantages remaining clear in patients with PD-L1 CPS≥5 points.In terms of safety,the risk of developing any AEs and grade≥3 AEs is relatively lowest with Chemo.