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Background <p>Advanced/recurrent endometrial cancer (EC) poses a significant therapeutic challenge. Immune checkpoint inhibitor (ICI) combined with chemotherapy (CT) represents a promising first-line approach, yet the predictive value of deficient/proficient mismatch repair (dMMR/pMMR) status and PD-L1 expression in therapeutic efficacy remains unclear. This study aimed to systematically evaluate the predictive value of dMMR/pMMR status and PD-L1 expression for progression-free survival (PFS) and overall survival (OS) in patients with advanced/recurrent EC treated with ICI + CT.</p> Methods <p>A systematic review and meta-analysis of randomized controlled trials (RCTs) from four databases (PubMed, Embase, Cochrane Library, Web of Science) was performed. PFS and OS were synthesized as hazard ratios (HRs) with 95% confidence intervals (CIs) using Review Manager 5.4.</p> Results <p>Five RCTs (2,707 patients) were included in this meta-analysis. Compared with CT alone, ICI + CT significantly improved PFS in all subgroups: dMMR (HR = 0.36, 95% CI:0.28–0.45, <i>P</i> &lt; 0.00001), pMMR (HR = 0.78, 95% CI:0.70–0.87, <i>P</i> = 0.009), PD-L1-positive (HR = 0.52, 95% CI:0.38–0.70, <i>P</i> &lt; 0.0001), and PD-L1-negative (HR = 0.66, 95% CI:0.44–0.98, <i>P</i> = 0.04). For OS, only the dMMR subgroup showed a significant benefit (HR = 0.41, 95% CI:0.28–0.61, <i>P</i> &lt; 0.00001), with no improvement observed in pMMR patients (HR = 0.88, 95% CI:0.73–1.07, <i>P</i> = 0.20).</p> Conclusion <p>For advanced/recurrent EC, ICI + CT enhanced PFS across dMMR/pMMR and PD-L1 expression subgroups, with OS benefit apparently confined to dMMR patients and not observed in pMMR patients. These results present the clinically valuable predictive value of MMR status for ICI + CT efficacy and suggest that PD-L1expression did not influence the benefit of ICI on patient PFS, which deserve high clinical attention.</p> Trial registration <p><a href="https://inplasy.com/inplasy-2026-03-0015/">https://inplasy.com/inplasy-2026-03-0015/</a>, identifier INPLASY202630015.</p>

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Predictive value of PD-L1 expression and dMMR/pMMR status for immune checkpoint inhibitor combined with chemotherapy in advanced/recurrent endometrial cancer: a meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月16日

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  • Lifang Lan,
  • Zhuangyan Tang,
  • Xiongwei Yao,
  • Hongmei Liao,
  • Yihua Yang

摘要

Background

Advanced/recurrent endometrial cancer (EC) poses a significant therapeutic challenge. Immune checkpoint inhibitor (ICI) combined with chemotherapy (CT) represents a promising first-line approach, yet the predictive value of deficient/proficient mismatch repair (dMMR/pMMR) status and PD-L1 expression in therapeutic efficacy remains unclear. This study aimed to systematically evaluate the predictive value of dMMR/pMMR status and PD-L1 expression for progression-free survival (PFS) and overall survival (OS) in patients with advanced/recurrent EC treated with ICI + CT.

Methods

A systematic review and meta-analysis of randomized controlled trials (RCTs) from four databases (PubMed, Embase, Cochrane Library, Web of Science) was performed. PFS and OS were synthesized as hazard ratios (HRs) with 95% confidence intervals (CIs) using Review Manager 5.4.

Results

Five RCTs (2,707 patients) were included in this meta-analysis. Compared with CT alone, ICI + CT significantly improved PFS in all subgroups: dMMR (HR = 0.36, 95% CI:0.28–0.45, P < 0.00001), pMMR (HR = 0.78, 95% CI:0.70–0.87, P = 0.009), PD-L1-positive (HR = 0.52, 95% CI:0.38–0.70, P < 0.0001), and PD-L1-negative (HR = 0.66, 95% CI:0.44–0.98, P = 0.04). For OS, only the dMMR subgroup showed a significant benefit (HR = 0.41, 95% CI:0.28–0.61, P < 0.00001), with no improvement observed in pMMR patients (HR = 0.88, 95% CI:0.73–1.07, P = 0.20).

Conclusion

For advanced/recurrent EC, ICI + CT enhanced PFS across dMMR/pMMR and PD-L1 expression subgroups, with OS benefit apparently confined to dMMR patients and not observed in pMMR patients. These results present the clinically valuable predictive value of MMR status for ICI + CT efficacy and suggest that PD-L1expression did not influence the benefit of ICI on patient PFS, which deserve high clinical attention.

Trial registration

https://inplasy.com/inplasy-2026-03-0015/, identifier INPLASY202630015.