SynthesisFrontiers in immunology2026
Efficacy and safety of first-line chemoimmunotherapy versus chemotherapy alone for advanced pulmonary lymphoepithelioma-like carcinoma: a systematic review and real-world cohort study.
Synthesis in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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10 authors.
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Abstract
Background: Primary pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare subtype of non-small cell lung cancer characterized by pronounced regional clustering and high PD-L1 expression. Although early studies suggest that first-line immunotherapy combined with chemotherapy has application potential, we still lack large-sample systematic reviews and cross-high-incidence-area real-world validation. Methods: The electronic databases were systematically searched from inception until January 31, 2026. Studies comparing first-line immunotherapy combined with chemotherapy versus chemotherapy alone in patients with advanced primary pulmonary lymphoepithelioma-like carcinoma (PLELC) were included. To validate the findings, an independent multicenter real-world cohort was concurrently incorporated. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Stata 15.0 and R software (utilizing inverse probability of treatment weighting [IPTW]) were used to synthesize the meta-analysis and adjust the real-world cohort data, respectively. Results: The initial meta-analysis (encompassing 606 patients) demonstrates that adding PD-1/PD-L1 inhibitors to chemotherapy significantly prolongs both progression-free survival (PFS) and overall survival (OS) without elevating the risk of severe adverse events. Within the independent multicenter cohort from Guangxi, the combination therapy group continues to display a profound PFS benefit after IPTW strictly balances the baseline disease burden (18.0 vs. 6.5 months, HR = 0.17, P < 0.001). OS in this cohort exhibits a protective trend (HR = 0.85); however, incorporating this real-world effect size into the global meta-model yields updated pooled data that further reinforces its robust, cross-regional survival advantage (PFS HR = 0.42; OS HR = 0.51). Multivariate prognostic analysis identifies baseline liver metastasis as an independent risk factor for reduced OS, whereas PD-L1 positivity significantly correlates with improved PFS. Conclusion: This integrated systematic review and multicenter real-world cohort study suggests the superior efficacy and safety of first-line chemoimmunotherapy over chemotherapy alone, providing evidence-based support for the management of advanced PPLELC.
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