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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 吳泓彥(Hon Yen Wu) | |
| dc.contributor.author | Tse-Yo Alice Huang | en |
| dc.contributor.author | 黃子祐 | zh_TW |
| dc.date.accessioned | 2022-11-25T05:36:33Z | - |
| dc.date.available | 2024-10-12 | |
| dc.date.copyright | 2021-11-09 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2021-10-18 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/82132 | - |
| dc.description.abstract | "背景 近年來,免疫檢查點抑製劑(Immune checkpoint inhibitors)已成為一類重要的癌症治療方法。根據文獻報告,免疫檢查點抑製劑或其組合治療效果在不同癌症類型存在很大的個體差異,目前觀察到的反應率約莫在15%到25%之間; 而造成該療效差異的預後因子仍在研究中,尚未得出一致的結論。統合分析已被應用於探討多種預後因子,包括PD-1和PD-L1表現,其他數種生物標記如年齡以及性別。本研究旨在針對白種人與亞洲人, 透過統合分析探討種族對免疫檢查點抑制的影響。 方法 作者從Pubmed和Embase數據庫中進行了系統性文獻檢索,搜尋自2015年1月1日至2020年12月30日之間相關的隨機對照試驗。我們萃取了27項研究比較了免疫檢查點抑製劑與標准治療(Standard of Care)或安慰劑 (Placebo) 在亞洲人以及白種人整體存活療效的隨機分派試驗 (Randomized Controlled Trials) 。非隨機分派試驗,生物標記研究,世代研究,回顧性研究,社論,評論文章均不包含在分析內。統合分析是在隨機效應模型下各別採用deft (靈巧的, 意即僅考量研究內的交互作用) 和deluded (誤導的, 意即考量研究間的以及研究內的交互作用)以統合迴歸方法進行,然後進行試驗序列分析(Trials sequential analysis, TSA),以查看該信息量是否已達到有統計學意義的閾值。 結果 所有27項研究的統合分析顯示,在混合效應模型下,亞洲人(hazard ratio [HR] 0.81; 95%CI 0.72-0.92; p = 0.07)和白種人(HR 0.83; 95%CI 0.76-0.90; p <0.01)使用免疫檢查點抑製劑相對於對照組均有整體存活優勢。使用統合迴歸分析並未觀察到兩個族群的整體存活效益之間存在有統計上顯著差異(p = 0.8407)。按第幾線治療、癌症部位、是否與化療合併使用, 以及免疫檢查點抑制劑種類分層的子分析,在亞洲人和白種人之間在免疫療法的療效上也沒有統計上的顯著差異。同樣的,試驗序列分析的數據顯示在亞洲人和白種人兩組之間沒有統計上差異,且在80% power的設定下,增加更多試驗可能不會改變結果。 討論及結論 通過這項統合分析,並且結合試驗序列分析數個免疫檢查點抑製劑的隨機臨床試驗結果,無論是亞洲和白種人的分析結果均顯示了相對於標準治療或是安慰劑, 免疫療法治療的整體存活療效較佳; 且兩組相比,無統計上差異。該結果表示在亞裔或白種人種族使用免疫治療時應可預期相近的治療效果。" | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-25T05:36:33Z (GMT). No. of bitstreams: 1 U0001-1010202111460700.pdf: 6633591 bytes, checksum: e80b99aa3c62debd308d44ab14f60b9a (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | 致謝 ii 中文摘要 1 Synopsis 3 圖 目 錄 7 表 目 錄 8 本文 1 Introduction 9 1.1 Mechanism and current state of ICIs 9 1.2 Major biomarkers under research 12 1.2.1 PD-L1 expression 12 1.2.2 Sex 14 1.2.3 Age 16 1.2.4 Race 18 2 Methods and Materials 37 2.1 Study design 37 2.2 Inclusion exclusion criteria 38 2.3 Statistical Analysis 39 3 Results 42 3.1 Systematic review 42 3.2 Meta-analysis (Meta-regression) 44 3.3 Subgroup Analysis 45 3.4 Trial Sequential Analysis 46 3.5 Progression Free Survival Analysis 46 4 Discussion 62 5 Conclusion 70 Reference……………………………………………………………………………72 圖 目 錄 Figure 1. PRISMA Diagram 47 Figure 2 A) Overall survival for Asian (Studies reported both Asian and White OS). 58 Figure 2 B) Overall survival for White (Studies reported both Asian and White OS).58 Figure 2 C) Clinical outcomes between Asian and White patients with ICI treatment59 Figure 3 A) Overall survival for Asian (All data) 59 Figure 3 B) Overall survival for White (All data)……………………………………60 Figure 4 Trials series analysis based on 14 included studies 61 Figure 5 A) Progression free survival for Asian (All data)………………………..…61 Figure 5 B) Progression free survival for White (All data)…………………………..61 Supplemantary Figure S1. Funnel plot and eggers test for publication bias………………………...112 Figure S2. Summary of overall survival in meta-analysis………………………….116 表 目 錄 Table 1. Characteristics of 27 included randomized controlled trials 48 Table 2. Racial subgroup analysis for ICI treatment efficacy differences 60 Supplementary Table S1. Jadad quality score of included studies……………………...…………….97 Table S2. Cochrane Risk of Bias excel tool………………………………………....99 Table S3. Racial stratification and participating countries of 27 included studies…101 | |
| dc.language.iso | en | |
| dc.subject | 統合分析 | zh_TW |
| dc.subject | 免疫檢查點抑制劑 | zh_TW |
| dc.subject | 種族 | zh_TW |
| dc.subject | 試驗序列分析 | zh_TW |
| dc.subject | PD-1 | zh_TW |
| dc.subject | CTLA-4 | zh_TW |
| dc.subject | PD-L1 | zh_TW |
| dc.subject | Meta-analysis | en |
| dc.subject | CTLA-4 | en |
| dc.subject | PD-L1 | en |
| dc.subject | PD-1 | en |
| dc.subject | Trial Series Analysis | en |
| dc.subject | Race | en |
| dc.subject | Immune checkpoint inhibitors | en |
| dc.title | 免疫檢查點抑制劑之有效性與種族(白種人與亞洲人)之相關性: 系統性回顧與統合分析 | zh_TW |
| dc.title | Efficacy of Immune Checkpoint Inhibitors and Association with Races (Among White and Asian): A Systematic Review and Meta-analysis | en |
| dc.date.schoolyear | 109-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.coadvisor | 杜裕康(Yu Kang Tu) | |
| dc.contributor.oralexamcommittee | 簡國龍(Hsin-Tsai Liu),許駿(Chih-Yang Tseng) | |
| dc.subject.keyword | 統合分析,免疫檢查點抑制劑,種族,試驗序列分析,PD-1,PD-L1,CTLA-4, | zh_TW |
| dc.subject.keyword | Meta-analysis,Immune checkpoint inhibitors,Race,Trial Series Analysis,PD-1,PD-L1,CTLA-4, | en |
| dc.relation.page | 116 | |
| dc.identifier.doi | 10.6342/NTU202103639 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2021-10-19 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
| dc.date.embargo-lift | 2024-10-12 | - |
| 顯示於系所單位: | 流行病學與預防醫學研究所 | |
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