肿瘤细胞治疗研究
英文原题：Dendritic Cell Vaccines for Glioblastoma: A Systematic Review and Meta-Analysis Comparing New-Onset and Recurrent Cases.
基于树突状细胞的免疫治疗可提高GBM患者的生存结局。结果显示，基于DC的免疫治疗在新诊断的GBM中比在复发病例中更有效。
胶质母细胞瘤（GBM）是一种侵袭性强且高度复发的脑肿瘤，尽管治疗取得了进展，它仍然是一个重大挑战。其中位生存期仅为15个月，且尽管初始治疗积极，复发往往在一年内发生，因此迫切需要更有效的治疗策略。遗传突变和肿瘤微环境改变等内在和外在因素的相互作用驱动了复发，凸显了靶向方法的重要性。新兴疗法，特别是基于树突状细胞（DC）的免疫疗法，在增强抗肿瘤免疫反应方面显示出前景。本研究旨在比较基于DC的免疫疗法在改善新诊断或复发GBM患者生存结局方面的有效性。
我们全面检索了截至2024年3月的四个电子数据库（Cochrane Central Register of Controlled Trials、PubMed、Scopus和Web of Science），以识别评估DC疫苗治疗新诊断和复发GBM疗效的相关研究。使用Cochrane偏倚风险第1版（RoB1）工具评估试验证据质量。将纳入研究的数据提取至标准化在线表格，并使用Review Manager（RevMan）5.4进行分析。
我们的检索共识别出3项记录，合计355例患者。meta分析结果显示，DC-based immunotherapy对复发性GBM的影响大于对新诊断GBM的影响。然而，总生存期有利于新诊断病例，显示出更强的保护作用（HR = 0.62，95%置信区间（CI）（0.46,0.84），p = 0.002），且无显著异质性（p = 0.97，I2 = 0%）。无进展生存期也观察到类似趋势，新诊断病例优于复发病例（HR = 0.56，95% CI（0.31,1.00），p = 0.05），且无显著异质性（p = 0.48，I2 = 0%）。此外，在12个月和24个月时的生存率方面也观察到可比的结果。
INTRODUCTION: Glioblastoma (GBM), an aggressive and highly recurrent brain tumor, remains a significant challenge despite advancements in treatment. With a median survival of only 15 months and recurrence often occurring within a year despite aggressive initial therapy, there is an urgent need for more effective therapeutic strategies. The interplay of intrinsic and extrinsic factors, such as genetic mutations and alterations in the tumor microenvironment, drives recurrence, highlighting the importance of targeted approaches. Emerging therapies, particularly dendritic cell (DC)-based immunotherapies, show promise in enhancing anti-tumor immune responses. This study aimed to compare the effectiveness of DC-based immunotherapy in improving survival outcomes for patients with newly diagnosed or recurrent GBM. METHODS: We conducted a comprehensive search across four electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Scopus, and Web of Science) up to March 2024 to identify pertinent studies evaluating the efficacy of DC vaccines in the treatment of both newly diagnosed and recurrent GBM. The quality of evidence from trials was assessed using the Cochrane risk-of-bias version 1 (RoB1) tool. Data from the included studies were extracted into a standardized online sheet and analyzed using Review Manager (RevMan) 5.4. RESULTS: Our search identified three records with a total of 355 patients. The results of the meta-analysis showed that DC-based immunotherapy had a greater impact on recurrent GBM than on newly diagnosed GBM. However, overall survival favored newly diagnosed cases, demonstrating a more protective effect (HR = 0.62, 95% confidence intervals (CI) (0.46,0.84), p = 0.002) with no significant heterogeneity (p = 0.97, I2 = 0%). A similar trend was observed for progression-free survival, favoring newly diagnosed cases over recurrent ones (HR = 0.56, 95% CI (0.31,1.00), p = 0.05), with no significant heterogeneity (p = 0.48, I2 = 0%). Moreover, comparable results were observed for survival at both 12 and 24 months. CONCLUSION: Dendritic cell-based immunotherapy can enhance survival outcomes in GBM patients. The results showed DC-based immunotherapy to be more effective in newly diagnosed GBM than in recurrent cases.
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