Immune-checkpoint inhibitors (ICIs) were proven effective in inducing tumor regression. However, its toxicity tends to be fatal. We sought to investigate the hospital volume/outcomes relationship. Databases were searched for studies reporting immune-checkpoint inhibitors adverse events (AEs) in patients with solid-organ malignancies. The outcomes were A) the pooled events rate (PER) of grade 5, grade 3–4, cardiac-related, and pulmonary-related AEs, and B) the assessment of the volume/outcomes relationship. One hundred and forty-seven studies met our inclusion criteria. The PER of grade 5, grade 3–4, and any-grade AEs was 2.75% (95%CI: 2.18–3.47), 26.69% (95%CI: 21.60–32.48), and 77.80% (95%CI: 70.91–83.44), respectively. The PER of pulmonary-related AEs was 4.56% (95%CI: 3.76–5.53). A higher number of annual cases per center was significantly associated with reduced grade 5 (p= 0.019), grade 3–4 (p= 0.004), and cardiac-related AEs (p= 0.035) in the meta-regression. In the current era of cancer immunotherapy, knowledge regarding the early diagnosis and management of immunotherapy-related AEs is essential. Our meta-analysis demonstrates the importance of center volume in improving outcomes and reducing the incidence of severe AEs.
免疫检查点抑制剂已被证实能有效诱导肿瘤消退，但其毒性反应可能致命。本研究旨在探讨医疗机构接诊量与临床结局之间的关联。通过系统检索数据库，纳入报告实体器官恶性肿瘤患者接受免疫检查点抑制剂治疗后发生不良事件的研究。主要结局指标包括：A）5级、3-4级、心脏相关及肺部相关不良事件的汇总发生率；B）接诊量与临床结局关系的评估。最终147项研究符合纳入标准。5级、3-4级及任意级别不良事件的汇总发生率分别为2.75%（95%CI：2.18-3.47）、26.69%（95%CI：21.60-32.48）和77.80%（95%CI：70.91-83.44）。肺部相关不良事件汇总发生率为4.56%（95%CI：3.76-5.53）。荟萃回归分析显示，医疗机构年均接诊病例数增加与5级（p=0.019）、3-4级（p=0.004）及心脏相关不良事件（p=0.035）发生率降低显著相关。在当今癌症免疫治疗时代，掌握免疫治疗相关不良事件的早期诊断和处理至关重要。本荟萃分析证实了医疗机构接诊规模对改善临床结局、降低严重不良事件发生率的重要影响。
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