International Journal of Molecular Medical Science, 2025, Vol.15, No.5, 224-234 http://medscipublisher.com/index.php/ijmms 2 27 trials comparing PD-1/PD-L1 inhibitors combined with chemotherapy and chemotherapy alone in the treatment of advanced resectable NSCLC. Inclusion criteria generally require studies to be histologically or cytologically confirmed phase II or phase III randomized controlled trials of non-small cell lung cancer, and report key indicators such as overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) (Fu et al., 2025). Multiple researchers will independently extract data, with a focus on extracting research characteristics, basic patient conditions, treatment plans and clinical outcomes. Researchers will also conduct subgroup analyses based on PD-L1 expression, histological type and other relevant clinical factors to ensure a reliable stratified assessment of the therapeutic effect (Wankhede et al., 2022; Zhao et al., 2025). Quality assessment tools such as the Cochrane Risk Bias Tool were used to determine whether the research methods were rigorous and to reduce bias (Liu et al., 2025). 4.2 Primary endpoints The results of the meta-analysis consistently showed that the addition of PD-1/PD-L1 inhibitors to chemotherapy could significantly improve the primary clinical outcomes of non-small cell lung cancer. For patients with advanced NSCLC, compared with chemotherapy alone, combination therapy can significantly reduce the risk of death (OS: HR 0.74-0.76) and the risk of disease progression (PFS: HR 0.61-0.65) (Figure 1) (Li et al., 2020; Liu et al., 2025). The objective response rate of combined therapy also significantly increased (ORR: OR 1.86-2.12), indicating that more patients experienced tumor shrinkage. These benefits were reflected in different subgroups of PD-L1 expression, including patients with low or negative PD-L1 expression (Wankhede et al., 2022). Figure 1 Network meta-analysis for OS and PFS of PD-1/PD-L1 inhibitors+chemotherapy vs. Chemotherapy (Adopted from Liu et al., 2025) Image caption: The analysis presents HR with 95% confidence interval for each treatment, showing the ranking and relative efficacy of PD-1/PD-L1 inhibitors+chemotherapy compared with chemotherapy. For comparisons of the OS (right upper half) and PFS (left lower half), a HR <1 favors the column defining treatment. Significant differences are boldly shown in the figure. Chem, chemotherapy; Dur-Chem, durvalumab+chemotherapy; Cemi-Chem, cemiplimab+chemotherapy; Cam-Chem, camrelizumab+chemotherapy; Niv-Chem, nivolumab+chemotherapy; Tis-Chem, tislelizumab+chemotherapy; Ate-Chem, atezolizumab+chemotherapy; HR, hazard ratio; OS, overall survival; PFS, progression-free survival; PD-1, programmed cell death-1; PD-L1, programmed death-ligand 1 (Adopted from Liu et al., 2025)
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