PD-1/PD-L1 inhibitor-based regimens in sarcomatoid renal cell carcinoma: a meta-analysis of randomized controlled trials and single-arm studies
Abstract
ObjectiveTo evaluate the efficacy of PD-1/PD-L1 inhibitor-based regimens in advanced or metastatic renal cell carcinoma with sarcomatoid differentiation (sRCC).MethodsPubMed, Embase, Web of Science, the Cochrane Library, Scopus, and ClinicalTrials.gov were searched through August 13, 2026. Randomized controlled trials (RCTs) comparing first-line combinations with sunitinib were synthesized using random-effects models with modified Hartung–Knapp inference. Risk ratios (RRs) were pooled for objective response rate (ORR) and complete response (CR), and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Prospective nonrandomized cohorts were summarized separately. Risk of bias and evidence certainty were assessed using RoB 2, MINORS, and GRADE.ResultsFifteen cohorts from 13 parent studies were included: six randomized sarcomatoid subgroups (618 patients) and nine prospective nonrandomized cohorts (150 patients at baseline). Compared with sunitinib, combination therapy improved ORR (RR 2.440, 95% CI 1.802–3.305), CR (RR 4.544, 95% CI 1.769–11.675), PFS (HR 0.480, 95% CI 0.360–0.639), and OS (HR 0.587, 95% CI 0.390–0.884). ORR, CR, and PFS remained statistically significant in all leave-one-out analyses; OS did not after omission of three individual trials. Evidence certainty was moderate for ORR and PFS and low for CR and OS.ConclusionsFirst-line PD-1/PD-L1-based combinations improve tumor response and PFS compared with sunitinib in patients with sRCC. The pooled OS benefit is promising but less robust. These findings support the use of the studied combinations while highlighting the need for more precise long-term survival estimates.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261490589.
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BibTeX
@article{zheng2026pd1pdl1,
title = {{PD-1/PD-L1 inhibitor-based regimens in sarcomatoid renal cell carcinoma: a meta-analysis of randomized controlled trials and single-arm studies}},
author = {Kailin Zheng and Lixiang Zhang and Zhilong Huang and Binhua Ye and Peng Ren and Qi Zhang},
journal = {Frontiers in Immunology},
year = {2026},
month = nov,
doi = {10.3389/fimmu.2026.1981596},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1981596},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - PD-1/PD-L1 inhibitor-based regimens in sarcomatoid renal cell carcinoma: a meta-analysis of randomized controlled trials and single-arm studies
AU - Kailin Zheng
AU - Lixiang Zhang
AU - Zhilong Huang
AU - Binhua Ye
AU - Peng Ren
AU - Qi Zhang
PY - 2026
DA - 2026/11/03
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1981596
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1981596
AB - ObjectiveTo evaluate the efficacy of PD-1/PD-L1 inhibitor-based regimens in advanced or metastatic renal cell carcinoma with sarcomatoid differentiation (sRCC).MethodsPubMed, Embase, Web of Science, the Cochrane Library, Scopus, and ClinicalTrials.gov were searched through August 13, 2026. Randomized controlled trials (RCTs) comparing first-line combinations with sunitinib were synthesized using random-effects models with modified Hartung–Knapp inference. Risk ratios (RRs) were pooled for objective response rate (ORR) and complete response (CR), and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Prospective nonrandomized cohorts were summarized separately. Risk of bias and evidence certainty were assessed using RoB 2, MINORS, and GRADE.ResultsFifteen cohorts from 13 parent studies were included: six randomized sarcomatoid subgroups (618 patients) and nine prospective nonrandomized cohorts (150 patients at baseline). Compared with sunitinib, combination therapy improved ORR (RR 2.440, 95% CI 1.802–3.305), CR (RR 4.544, 95% CI 1.769–11.675), PFS (HR 0.480, 95% CI 0.360–0.639), and OS (HR 0.587, 95% CI 0.390–0.884). ORR, CR, and PFS remained statistically significant in all leave-one-out analyses; OS did not after omission of three individual trials. Evidence certainty was moderate for ORR and PFS and low for CR and OS.ConclusionsFirst-line PD-1/PD-L1-based combinations improve tumor response and PFS compared with sunitinib in patients with sRCC. The pooled OS benefit is promising but less robust. These findings support the use of the studied combinations while highlighting the need for more precise long-term survival estimates.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261490589.
SN - 1664-3224
ER -