化学免疫疗法是复发性或晚期错配修复缺陷 (dMMR) 子宫内膜癌 (EC) 女性的标准治疗方法。然而，尚不确定 dMMR 晚期或复发性 EC 患者从化疗中获得的益处是否低于错配修复良好 (pMMR) EC 患者。我们对晚期/复发性 EC 的随机对照试验 (RCT) 进行了荟萃分析，以确定dMMR 与 pMMR EC 化疗获益的差异。检索化疗结果的数据，包括客观缓解率（ORR）、无进展生存期（PFS）和总生存期（OS）。我们使用逆方差法汇总这些数据，并通过 MMR 状态检查亚组差异。我们还通过根据试验出版物的 Kaplan-Meier 曲线创建个体患者数据进行敏感性分析，比较了 PFS 和 OS 结果的差异。总共纳入了 5 项随机对照试验，涉及 1137 名受试者（dMMR，26%；pMMR，74%）。所有参与者均接受基于卡铂的化疗。 dMMR 和 pMMR 亚组之间的 ORR 没有差异（66.5% vs 64.0%，亚组差异 P = .20）、PFS（HR 0.93，95% CI 0.77-1.12，P = .44；中位 PFS 7.6 vs 9.5）月）或 OS（HR 1.03，95% CI 0.73-1.44，P = .88；中位 OS 未达到 vs 28.6 个月）。接受一线治疗的 dMMR 与 pMMR 子宫内膜癌患者的 ORR、PFS 和 OS 相似，随机临床试验中的铂类双药化疗。这些发现强调了将化疗与免疫检查点抑制剂联合使用的重要性，直到获得比较单独免疫检查点疗法与联合疗法的试验结果为止。© 作者 2024。由牛津大学出版社出版。

Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient (dMMR) endometrial carcinomas (EC). However, it is uncertain whether patients with dMMR advanced or recurrent EC derive less benefit from chemotherapy than those with mismatch repair proficient (pMMR) EC.We performed a meta-analysis of randomized controlled trials (RCTs) in advanced/recurrent EC to determine the difference in the benefit of chemotherapy in dMMR vs pMMR EC. Data on chemotherapy outcomes including objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by MMR status. We also compared differences in PFS and OS outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.A total of five RCTs with 1137 participants (dMMR, 26%; pMMR, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the dMMR and pMMR subgroups for ORR (66.5% vs 64.0%, P = .20 for subgroup difference), PFS (HR 0.93, 95% CI 0.77-1.12, P = .44; median PFS 7.6 vs 9.5 months) or OS (HR 1.03, 95% CI 0.73-1.44, P = .88; median OS not reached vs 28.6 months).ORR, PFS and OS were similar among those with dMMR vs pMMR endometrial cancer treated with front-line, platinum-doublet chemotherapy in randomized clinical trials. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.© The Author(s) 2024. Published by Oxford University Press.