Cytokine-induced killer cells/dendritic cells and cytokine-induced killer cells immunotherapy for the treatment of esophageal cancer in China: a meta-analysis

Background: Immunotherapy based on cytokine-induced killer cells or combination of dendritic cells and cytokine-induced killer cells (CIK/DC-CIK) showed promising clinical outcomes for treating esophageal cancer (EC). However, the clinical benefit varies among previous studies. Therefore, it is necessary to systematically evaluate the curative efficacy and safety of CIK/ DC-CIK immunotherapy as an adjuvant therapy for conventional therapeutic strategies in the treatment of EC. Materials and methods: Clinical trials published before October 2016 and reporting CIK/ DC-CIK immunotherapy treatment responses or safety for EC were searched in Cochrane Library, EMBASE, PubMed, Wanfang and China National Knowledge Internet databases. Research quality and heterogeneity were evaluated before analysis, and pooled analyses were performed using random-or fixed-effect models. Results: This research covered 11 trials including 994 EC patients. Results of this metaanalysis indicated that compared with conventional therapy, the combination of conventional therapy with CIK/DC-CIK immunotherapy significantly prolonged the 1-year overall survival (OS) rate, overall response rate (ORR) and disease control rate (DCR) (1-year OS: P=0.0005; ORR and DCR: P<0.00001). Patients with combination therapy also showed significantly improved quality of life (QoL) (P=0.02). After CIK/DC-CIK immunotherapy, lymphocyte percentages of CD3(+) and CD3(-)CD56(+) subsets (P<0.01) and cytokines levels of IFN-gamma, -2, TNF-alpha and IL-12 (P<0.00001) were significantly increased, and the percentage of cluster of differentiation (CD) 4(+) CD25(+) CD127(-) subset was significantly decreased, whereas analysis of CD4(+), CD8(+), CD4(+)/CD8(+) and CD3(+) CD56(+) did not show significant difference (P>0.05). Conclusion: The combination of CIK/DC-CIK immunotherapy and conventional therapy is safe and markedly prolongs survival time, enhances immune function and improves the treatment efficacy for EC.