中国癌症杂志2025，Vol.35Issue(12)：1126-1139,14.DOI:10.19401/j.cnki.1007-3639.2025.12.005
PD-1/PD-L1抑制剂联合放化疗对比放化疗在恶性肿瘤治疗中的相关心脏毒性:系统综述及Meta分析
Risk of cancer therapy-related cardiotoxicity following the use of PD-1/PD-L1 inhibitors combined with chemoradiotherapy compared with chemoradiotherapy in solid tumors:a systematic review and Meta-analysis
摘要
Abstract
Programmed cell death receptor-1(PD-1)/programmed cell death-ligand 1(PD-L1)inhibitors combined with chemoradiotherapy has become a breakthrough therapy for a variety of tumors,but its safety is still uncertain.The aim of this study was to investigate the risk of cardiotoxicity of PD-1/PD-L1 inhibitors combined with chemoradiotherapy in patients with malignant solid tumors.This study has been registered in PROSPERO(CRD42024612785).We systematically searched for randomized controlled trials evaluating PD-1/PD-L1 inhibitors combined with chemoradiotherapy in patients with malignant solid tumors in China National Knowledge Infrastructure(CNKI),VIP Database,Wanfang Data,China Biology Medicine Disc,PubMed,Embase and Cochrane Library.The search period was from Jan.2019 to Aug.2024.Data extraction and quality evaluation were performed on all included studies.Meta-analysis and publication bias analysis were performed using R 4.4.3.Nine trials involving 6 329 cancer patients were included.The results showed that the use of PD-1/PD-L1 inhibitors combined with chemoradiotherapy increased cancer therapy-related cardiotoxicity(OR=2.03,95%CI:1.38-2.98,P＜0.05),especially cancer therapy-related grade 3-5 cardiac dysfunction(OR=2.50,95%CI:1.29-4.83,P＜0.05)and arrhythmia(OR=2.57,95%CI:1.22-5.40,P＜0.05).However,the risk of grade 3-5 coronary heart disease(OR=0.97,95%CI:0.47-1.98,P＞0.05)was not significantly increased.Subgroup analyses were simultaneously performed for ICI class(PD-1 inhibitors vs PD-L1 inhibitors),chemotherapy regimen(platinum-based monotherapy vs platinum-based combination therapy),and radiation dose(＜70 Gy vs≥70 Gy).The results demonstrated that the differences across these subgroups were not statistically significant.Combining PD-1/PD-L1 inhibitors with chemoradiotherapy is associated with an increased risk of cardiotoxicity,particularly cancer therapy-related cardiac dysfunction and arrhythmias,which requires heightened clinical awareness.关键词
恶性实体瘤/PD-1/PD-L1抑制剂/放化疗/肿瘤治疗相关心脏毒性/Meta分析Key words
Malignant solid tumors/PD-1/PD-L1 inhibitor/Chemoradiotherapy/Cancer therapy-related cardiotoxicity/Meta-analysis分类
医药卫生引用本文复制引用
ZHENG Jinmei,WU Wanghui,ZHENG Jimei,LIU Ji,WU Fei,WANG Mingxuan,SU Qiang..PD-1/PD-L1抑制剂联合放化疗对比放化疗在恶性肿瘤治疗中的相关心脏毒性:系统综述及Meta分析[J].中国癌症杂志,2025,35(12):1126-1139,14.基金项目
北京市科委-教委科技发展计划重点项目(KZ202010025047) （KZ202010025047）
国家自然科学基金重大研究计划培育项目(92046015) （92046015）
国家自然科学基金(72274127). Key Project of Science and Technology Development Plan by Beijing Municipal Commission of Science and Technology and Education Commission(KZ202010025047) （72274127）
Cultivation Project of Major Research Program by National Natural Science Foundation of China(92046015).National Natural Science Foundation of China(72274127). （92046015）
