This study aimed to systematically analyze the effect of a serine/threonine kinase (STK11) mutation (STK11mut) on therapeutic efficacy and prognosis in patients with non-small cell lung cancer (NSCLC). Candidate articles were identified through a search of relevant literature published on or before April 1, 2023, in PubMed, Embase, Cochrane Library, CNKI and Wanfang databases. The extracted and analyzed data included the hazard ratios (HRs) of PFS and OS, the objective response rate (ORR) of immune checkpoint inhibitors (ICIs), and the positive rates of PD-L1 expression. The HR of PFS and OS and the merged ratios were calculated using a meta-analysis. The correlation between STK11mut and clinical characteristics was further analyzed in NSCLC datasets from public databases. Fourteen retrospective studies including 4317 patients with NSCLC of whom 605 had STK11mut were included. The meta-analysis revealed that the ORR of ICIs in patients with STK11mut was 10.1% (95%CI 0.9–25.2), and the positive rate of PD-L1 expression was 41.1% (95%CI 25.3–57.0). STK11mut was associated with poor PFS (HR = 1.49, 95%CI 1.28–1.74) and poor OS (HR = 1.44, 95%CI 1.24–1.67). In the bioinformatics analysis, PFS and OS in patients with STK11 alterations were worse than those in patients without alterations (p < 0.001, p = 0.002). Nutlin-3a, 5-fluorouracil, and vinorelbine may have better sensitivity in patients with STK11mut than in those with STK11wt. Patients with STK11-mutant NSCLC had low PD-L1 expression and ORR to ICIs, and their PFS and OS were worse than patients with STK11wt after comprehensive treatment. In the future, more reasonable systematic treatments should be explored for this subgroup of patients with STK11-mutant NSCLC.

中文翻译：

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STK11突变对非小细胞肺癌患者疗效和预后的影响：基于荟萃分析和生物信息学分析的综合研究

本研究旨在系统分析丝氨酸/苏氨酸激酶（STK11）突变（STK11mut）对非小细胞肺癌（NSCLC）患者治疗效果和预后的影响。候选文章是通过检索2023年4月1日或之前在PubMed、Embase、Cochrane Library、CNKI和万方数据库中发表的相关文献来确定的。提取并分析的数据包括PFS和OS的风险比（HR）、免疫检查点抑制剂（ICIs）的客观缓解率（ORR）以及PD-L1表达的阳性率。使用荟萃分析计算 PFS 和 OS 的 HR 以及合并比率。在公共数据库的 NSCLC 数据集中进一步分析了 STK11mut 与临床特征之间的相关性。纳入了 14 项回顾性研究，包括 4317 名 NSCLC 患者，其中 605 名携带 STK11mut。 Meta分析显示，STK11mut患者ICIs的ORR为10.1%（95%CI 0.9-25.2），PD-L1表达阳性率为41.1%（95%CI 25.3-57.0）。 STK11mut 与较差的 PFS（HR = 1.49，95%CI 1.28–1.74）和较差的 OS（HR = 1.44，95%CI 1.24–1.67）相关。在生物信息学分析中，STK11 改变的患者的 PFS 和 OS 比没有改变的患者差（p < 0.001，p = 0.002）。 Nutlin-3a、5-氟尿嘧啶和长春瑞滨在 STK11mut 患者中可能比 STK11wt 患者具有更好的敏感性。 STK11突变型NSCLC患者PD-L1表达较低，对ICIs的ORR较低，综合治疗后的PFS和OS较STK11wt患者差。未来应针对该亚组STK11突变NSCLC患者探索更合理的系统治疗方法。