From: Immune checkpoint inhibitors in gastrointestinal malignancies: an Umbrella review
 | OS | PFS |  | OS | PFS |  | OS | PFS |
---|---|---|---|---|---|---|---|---|
NO | HR (95%CI) | NO | HR (95%CI) | NO | HR (95%CI) | |||
A) Hepatocellular carcinoma | ||||||||
Age | Â | Â | Â | 0.783 | Â | Â | Â | 0.145 |
  ≥ 65 yr | 4 | 0.80 (0.71, 0.91) | 0.0% (0.454) |  | 2 | 0.65 (0.52, 0.82) | 0.0% (0.795) |  |
  < 65 yr | 4 | 0.82 (0.72, 0.94) | 0.0% (0.892) |  | 1 | 0.89 (0.63, 1.26) | NA |  |
Sex | Â | Â | Â | 0.647 | Â | Â | Â | 0.629 |
 Male | 4 | 0.77 (0.69, 0.86) | 0.0% (0.457) |  | 2 | 0.66 (0.55, 0.80) | 30.3% (0.231) |  |
 Female | 4 | 0.82 (0.64, 1.07) | 0.0% (0.442) |  | 2 | 0.60 (0.40, 0.89) | 0.0% (0.968) |  |
ECOG performance status | Â | Â | Â | 0.689 | Â | Â | Â | 0.614 |
 0 | 5 | 0.77 (0.68, 0.88) | 0.0% (0.474) |  | 3 | 0.60 (0.50, 0.72) | 0.0%, (0.592) |  |
 1 | 5 | 0.74 (0.65, 0.86) | 44.6% (0.124) |  | 3 | 0.64 (0.53, 0.78) | 24.3%, (0.267) |  |
Location | Â | Â | Â | 0.078 | Â | Â | Â | 0.171 |
 Asia | 7 | 0.75 (0.67, 0.84) | 0.0% (0.534) |  | 4 | 0.63 (0.54, 0.75) | 44.9% (0.142) |  |
 Rest of the world | 6 | 0.86 (0.78, 0.96) | 0.0% (0.557) |  | 3 | 0.74 (0.63, 0.87) | 0.0% (0.872) |  |
AFP at baseline | Â | Â | Â | 0.368 | Â | Â | Â | 0.021 |
  ≥ 400 ng/mL | 5 | 0.66 (0.57, 0.77) | 0.0% (0.942) |  | 2 | 0.64 (0.53, 0.78) | 35.5% (0.213) |  |
  < 400 ng/mL | 5 | 0.75 (0.60, 0.93) | 59.8% (0.041) |  | 2 | 0.46 (0.37, 0.56) | 0.0%, (0.541) |  |
Barcelona liver stage | Â | Â | Â | 0.332 | Â | Â | Â | 0.843 |
 B | 6 | 0.89 (0.63, 1.24) | 50.7% (0.071) |  | 3 | 0.63 (0.45, 0.89) | 48.0% (0.146) |  |
 C | 6 | 0.74 (0.66, 0.84) | 34.5%, (0.177) |  | 3 | 0.61 (0.53, 0.70) | 0.0% (0.682) |  |
Macrovascular invasion at study entry | Â | Â | Â | 0.365 | Â | Â | Â | 0.598 |
 Yes | 5 | 0.71 (0.60, 0.84) | 0.0%, (0.425) |  | 3 | 0.58 (0.46, 0.74) | 0.0% (0.546) |  |
 No | 5 | 0.78 (0.70, 0.87) | 29.0% (0.228) |  | 3 | 0.63 (0.54, 0.73) | 6.4% (0.344) |  |
Extrahepatic spread at study entry | Â | Â | Â | 0.06 | Â | Â | Â | 0.213 |
 Yes | 5 | 0.70 (0.62, 0.78) | 49.7% (0.093) |  | 3 | 0.58 (0.50, 0.67) | 0.0% (0.440) |  |
 No | 5 | 0.84 (0.72, 0.98) | 0.0%, (0.811) |  | 3 | 0.70 (0.54, 0.89) | 0.0% (0.368) |  |
MVI and/or extrahepatic spread at study entry | Â | Â | Â | 0.017 | Â | Â | Â | 0.103 |
 Yes | 6 | 0.72 (0.66, 0.80) | 15.8%, (0.312) |  | 3 | 0.55 (0.47, 0.65) | 0.0% (0.932) |  |
 No | 6 | 0.91 (0.78, 1.08) | 46.4%, (0.097) |  | 3 | 0.73 (0.54, 0.98) | 15.7% (0.305) |  |
Etiology | Â | Â | Â | 0.001 | Â | Â | Â | 0.028 |
 Hepatitis B | 7 | 0.65 (0.57, 0.74) | 0.0%, (0.514) |  | 4 | 0.54 (0.46, 0.64) | 0.0%, (0.508) |  |
 Hepatitis C | 6 | 0.92 (0.77, 1.09) | 42.1%, (0.125) |  | 3 | 0.60 (0.43, 0.84) | 0.0%, (0.633) |  |
 Nonviral | 6 | 0.87 (0.77, 0.98) | 0.0%, (0.502) |  | 3 | 0.78 (0.63, 0.96) | 0.0%, (0.658) |  |
B) Gastric cancer | ||||||||
Age | Â | Â | Â | 0.844 | Â | Â | Â | 0.987 |
  ≥ 65 yr | 9 | 0.84 (0.77, 0.93) | 39.3%, (0.106) |  | 2 | 1.06 (0.64, 1.74) | 75.3%, (0.044) |  |
  < 65 yr | 9 | 0.85 (0.79, 0.93) | 13.0%, (0.326) |  | 2 | 1.07 (0.32, 3.52) | 96.5%, (0.000) |  |
Sex | Â | Â | Â | 0.046 | Â | Â | Â | 0.688 |
 Male | 9 | 0.82 (0.76, 0.88) | 33.9%, (0.147) |  | 2 | 1.03 (0.48, 2.18) | 93.6%, (0.000) |  |
 Female | 9 | 0.94 (0.84, 1.06) | 0.0%, (0.517) |  | 2 | 1.40 (0.38, 5.18) | 94.3%, (0.000) |  |
ECOG performance status | Â | Â | Â | 621 | Â | Â | Â | 0.700 |
 0 | 8 | 0.89 (0.77, 1.03) | 43.0%, (0.092) |  | 2 | 1.29 (0.46, 3.67) | 93.4%, (0.000) |  |
 1 | 8 | 0.84 (0.74, 0.97) | 54.4%, (0.032) |  | 2 | 0.99 (0.41, 2.39) | 94.1%, (0.000) |  |
Location | Â | Â | Â | 0.884 | Â | Â | Â | 0.372 |
 Asia | 8 | 0.85 (0.75, 0.97) | 32.1%, (0.171) |  | 2 | 1.91 (1.38, 2.64) | 12.3%, (0.286) |  |
 Rest of the world | 7 | 0.86 (0.80, 0.93) | 0.0%, (0.732) |  | 1 | 1.57 (1.19, 2.08) | NA |  |
Lauren histological type | Â | Â | Â | 0.449 | Â | Â | Â | 0.09 |
 Diffuse type | 6 | 0.85 (0.76, 0.96) | 43.7%, (0.114) |  | 1 | 0.84 (0.62, 1.14) | NA |  |
 Intestinal type | 6 | 0.80 (0.71, 0.90) | 12.9%, (0.332) |  | 1 | 0.56 (0.39, 0.80) | NA |  |
Primary sites | Â | Â | Â | 0.986 | Â | Â | Â | 0.666 |
 Gastric cancer | 9 | 0.87 (0.78, 0.97) | 51.1%, (0.037) |  | 2 | 1.16 (0.44, 3.09) | 95.9%, (0.000) |  |
 Gastroesophageal junction cancer | 9 | 0.87 (0.76, 0.99) | 0.0%, (0.641) |  | 2 | 0.89 (0.44, 1.81) | 65.8%, (0.087) |  |
Liver metastasis | Â | Â | Â | 0.344 | Â | Â | Â | 0.204 |
 Yes | 3 | 0.72 (0.63, 0.84) | 0.0%, (0.899) |  | 1 | 0.59 (0.42, 0.83) | NA |  |
 No | 3 | 0.82 (0.66, 1.03) | 72.2%, (0.027) |  | 1 | 0.79 (0.59, 1.05) | NA |  |
Lymph node metastasis | Â | Â | Â | 0.405 | Â | Â | Â | 0.559 |
 Yes | 1 | 0.94 (0.77, 1.15) | NA |  | 1 | 0.73 (0.58, 0.92) | NA |  |
 No | 1 | 0.77 (0.50, 1.18) | NA |  | 1 | 0.61 (0.35, 1.06) | NA |  |
Peritoneal metastasis | Â | Â | Â | 0.130 | Â | Â | Â | 0.002 |
 Yes | 2 | 0.98 (0.61, 1.56) | 72.1%, (0.058) |  | 1 | 1.04 (0.76, 1.43) | NA |  |
 No | 2 | 0.66 (0.55, 0.79) | 0.0%, (0.687) |  | 1 | 0.51 (0.37, 0.70) | NA |  |
Number of organs with metastases | Â | Â | Â | 0.245 | Â | Â | Â | 0.014 |
  < 2 | 4 | 0.72 (0.60, 0.85) | 0.0%, (0.672) |  | 1 | 0.42 (0.26, 0.69) | NA |  |
  ≥ 2 | 4 | 0.84 (0.68, 1.04) | 78.4%, (0.003) |  | 1 | 0.84 (0.66, 1.07) | NA |  |
Microsatellite status | Â | Â | Â | 0.000 | Â | Â | Â | Â |
 Stable | 5 | 0.87 (0.79, 0.95) | 42.1%, (0.178) |  |  |  |  |  |
 Unstable (Instability-high) | 3 | 0.33 (0.20, 0.52) | 0.0%, (0.988) |  |  |  |  |  |
Prior gastrectomy | Â | Â | Â | 0.924 | Â | Â | Â | 0.956 |
 Yes | 4 | 0.89 (0.73, 1.08) | 0.0%, (0.913) |  | 1 | 0.71 (0.46, 1.10) | NA |  |
 No | 4 | 0.90 (0.80, 1.00) | 0.0%, (0.826) |  | 1 | 0.70 (0.54, 0.90) | NA |  |
Disease status | Â | Â | Â | 0.313 | Â | Â | Â | Â |
 Metastatic | 2 | 0.91 (0.77, 1.07) | 0.0%, (0.633) |  |  |  |  |  |
 Locally advanced | 1 | 2.84 (0.31,25.74) | NA |  |  |  |  |  |
C) Esophageal cancer | ||||||||
Age | Â | Â | Â | 0.175 | Â | Â | Â | 0.133 |
  ≥ 65 yr | 9 | 0.67 (0.60, 0.75) | 0.0% (0.701) |  | 6 | 0.58 (0.51, 0.66) | 37.9%, (0.154) |  |
  < 65 yr | 9 | 0.74 (0.68, 0.81) | 0.0%,(0.623) |  | 6 | 0.66 (0.60, 0.73) | 44.3%, (0.110) |  |
Sex | Â | Â | Â | 0.029 | Â | Â | Â | 0.588 |
 Male | 10 | 0.72 (0.67, 0.77) | 26.6%, (0.199) |  | 6 | 0.63 (0.54, 0.75) | 67.2%, (0.009) |  |
 Female | 10 | 0.90 (0.75, 1.08) | 9.1%, (0.359) |  | 6 | 0.69 (0.54, 0.89) | 0.0%, (0.655) |  |
ECOG performance status | Â | Â | Â | 0.623 | Â | Â | Â | 0.674 |
 0 | 10 | 0.74 (0.66, 0.83) | 0.0%, (0.449) |  | 6 | 0.61 (0.50, 0.76) | 34.6%, (0.177) |  |
 1 | 10 | 0.71 (0.66, 0.78) | 0.0%, (0.739) |  | 6 | 0.65 (0.56, 0.75) | 53.5%, (0.056) |  |
Location | Â | Â | Â | 0.145 | Â | Â | Â | 0.889 |
 Asia | 4 | 0.71 (0.62, 0.80) | 18.8% (0.296) |  | 2 | 0.68 (0.51, 0.91) | 69.6%, (0.070) |  |
 Rest of the world | 4 | 0.84 (0.69, 1.02) | 54.6%, (0.086) |  | 1 | 0.70 (0.56, 0.88) | NA |  |
Histology | Â | Â | Â | 0.240 | Â | Â | Â | 0.239 |
 Adenocarcinoma | 2 | 0.92 (0.61, 1.38) | 73.3%, (0.053) |  | 1 | 0.63 (0.46, 0.87) | NA |  |
 Squamous cell carcinoma | 11 | 0.72 (0.67, 0.77) | 0.0%, (0.860) |  | 10 | 0.79 (0.65, 0.95) | 84.9%, (0.000) |  |
Liver metastasis | Â | Â | Â | 0.358 | Â | Â | Â | 0.451 |
 Yes | 4 | 0.64 (0.51, 0.80) | 0.0%, (0.792) |  | 3 | 0.75 (0.48, 1.15) | 67.0%, (0.048) |  |
 No | 4 | 0.72 (0.63, 0.83) | 0.0%, (0.738) |  | 3 | 0.62 (0.48, 0.79) | 61.8%, (0.073) |  |
Lymph node metastasis | Â | Â | Â | 0.319 | Â | Â | Â | Â |
 Yes | 2 | 0.80 (0.65, 0.98) | 0.0%, (0.540) |  |  |  |  |  |
 No | 2 | 0.68 (0.55, 0.86) | 0.0%, (0.702) |  |  |  |  |  |
Number of organs with metastases | Â | Â | Â | 0.169 | Â | Â | Â | 0.138 |
  < 2 | 5 | 0.79 (0.69, 0.91) | 0.0%, (0.923) |  | 2 | 0.70 (0.56, 0.86) | 0.0%, (0.350) |  |
  ≥ 2 | 5 | 0.70 (0.62, 0.79) | 0.0%, (0.454) |  | 2 | 0.56 (0.46, 0.68) | 44.0%, (0.181) |  |
Disease status | Â | Â | Â | 0.063 | Â | Â | Â | 0.408 |
 Metastatic | 6 | 0.66 (0.60, 0.74) | 0.0%, (0.802) |  | 4 | 0.58 (0.52, 0.65) | 0.0%, (0.409) |  |
 Locally advanced | 6 | 0.80 (0.68, 0.95) | 0.0%, (0.833) |  | 4 | 0.65 (0.50, 0.85) | 0.0%, (0.847) |  |
Smoking history | Â | Â | Â | 0.806 | Â | Â | Â | 0.852 |
 Never | 5 | 0.77 (0.62, 0.95) | 0.0%, (0.565) |  | 2 | 0.79 (0.47, 1.32) | 58.8%, (0.119) |  |
 Current or former | 5 | 0.75 (0.67, 0.83) | 0.0%, (0.867) |  | 2 | 0.73 (0.39, 1.36) | 85.8%, (0.008) |  |
D) Colorectal cancer | ||||||||
Age | Â | Â | Â | 0.570 | Â | Â | Â | 0.804 |
  ≥ 65 yr | 3 | 0.89 (0.52, 1.54) | 69.1%, (0.039) |  | 3 | 1.07 (0.81, 1.40) | 0.0%, (0.539) |  |
  < 65 yr | 3 | 1.06 (0.85, 1.32) | 0.1%, (0.368) |  | 3 | 1.11 (0.91, 1.35) | 47.8%, (0.147) |  |
Sex | Â | Â | Â | 0.963 | Â | Â | Â | 0.080 |
 Male | 2 | 0.73 (0.55, 0.95) | 0.0%, (0.383) |  | 1 | 0.77 (0.57, 1.05) | NA |  |
 Female | 2 | 0.72 (0.50, 1.03) | 39.0%, (0.200) |  | 1 | 1.21 (0.81, 1.80) | NA |  |
ECOG performance status | Â | Â | Â | 0.926 | Â | Â | Â | 0.806 |
 0 | 4 | 0.91 (0.55, 1.50) | 75.0%, (0.007) |  | 3 | 1.24 (0.66, 2.32) | 86.2%, (0.001) |  |
 1 | 4 | 0.88 (0.71, 1.09) | 13.0%, (0.327) |  | 3 | 1.14 (0.90, 1.44) | 0.0%, (0.623) |  |
Location | Â | Â | Â | 0.753 | Â | Â | Â | Â |
 Asia | 1 | 0.65 (0.27, 1.56) | NA |  |  |  |  |  |
 Rest of the world | 1 | 0.76 (0.52, 1.09) | NA |  |  |  |  |  |
BRAF status | Â | Â | Â | 0.507 | Â | Â | Â | Â |
 Wild type | 3 | 0.61 (0.39, 0.95) | 0.0%, (0.720) |  |  |  |  |  |
 Variant | 2 | 0.71 (0.52, 0.96) | 0.0%, (0.375) |  |  |  |  |  |
KRAS/NRAS status | Â | Â | Â | 0.569 | Â | Â | Â | Â |
 Wild type | 2 | 0.61 (0.39, 0.95) | 0.0%, (0.720) |  |  |  |  |  |
 Variant | 2 | 0.71 (0.52, 0.96) | 0.0%, (0.375) |  |  |  |  |  |
Liver metastasis | Â | Â | Â | 0.044 | Â | Â | Â | 0.751 |
 Yes | 1 | 1.14 (0.72, 1.81) | NA |  | 2 | 0.86 (0.69, 1.09) | 0.0%, (0.512) |  |
 No | 1 | 0.33 (0.11, 1.00) | NA |  | 2 | 0.80 (0.51, 1.24) | 0.0%, (0.523) |  |
Site of primary tomur | Â | Â | Â | 0.358 | Â | Â | Â | 0.519 |
 Right | 3 | 0.78 (0.58, 1.06) | 0.0%, (0.715) |  | 3 | 1.00 (0.71, 1.39) | 0.0%, (0.947) |  |
 Left | 3 | 0.95 (0.71, 1.28) | 0.0%, (0.812) |  | 3 | 1.13 (0.92, 1.40) | 26.0%, (0.259) |  |
Microsatellite status | Â | Â | Â | 0.402 | Â | Â | Â | 0.622 |
 Stable | 3 | 0.91 (0.64, 1.28) | 68.9%, (0.040) |  | 3 | 1.07 (0.71, 1.61) | 77.2%, (0.012) |  |
 Unstable (Instability-high) | 1 | 0.74 (0.53, 1.03) | NA |  | 2 | 0.84 (0.35, 2.01) | 60.5%, (0.111) |  |
Number of organs with metastases | Â | Â | Â | Â | Â | Â | Â | 0.668 |
  < 2 |  |  |  |  | 1 | 0.98 (0.68, 1.41) | NA |  |
  ≥ 2 |  |  |  |  | 1 | 0.88 (0.63, 1.22) | NA |  |
E) Pancreatic cancer | ||||||||
Age | Â | Â | Â | 0.491 | Â | Â | Â | 0.177 |
  ≥ 65 yr | 2 | 0.92 (0.67, 1.25) | 0.0%, (0.837) |  | 1 | 0.73 (0.48, 1.11) | NA |  |
  < 65 yr | 2 | 0.72 (0.39, 1.34) | 69.6%, (0.070) |  | 1 | 0.48 (0.31, 0.75) | NA |  |
Sex | Â | Â | Â | 0.486 | Â | Â | Â | 0.234 |
 Male | 2 | 0.72 (0.52, 0.99) | 42.7%, (0.187) |  | 1 | 0.52 (0.35, 0.77) | NA |  |
 Female | 2 | 0.85 (0.60, 1.20) | 0.0%, (0.947) |  | 1 | 0.76 (0.47, 1.23) | NA |  |
ECOG performance status | Â | Â | Â | 0.444 | Â | Â | Â | 0.056 |
 0 | 2 | 0.72 (0.32, 1.65) | 75.4%, (0.044) |  | 1 | 0.47 (0.31, 0.71) | NA |  |
 1 | 2 | 1.01 (0.81, 1.26) | 0.0%, (0.461) |  | 1 | 0.87 (0.54, 1.41) | NA |  |
F) Biliary tract cancer | ||||||||
Age | Â | Â | Â | 0.949 | Â | Â | Â | 0.211 |
  ≥ 65 yr | 1 | 0.79 (0.60, 1.04) | NA |  | 1 | 0.84 (0.66, 1.07) | NA |  |
  < 65 yr | 1 | 0.80 (0.61, 1.04) | NA |  | 1 | 0.68 (0.54, 0.85) | NA |  |
Sex | Â | Â | Â | 0.797 | Â | Â | Â | 0.696 |
 Male | 1 | 0.78 (0.60, 1.01) | NA |  | 1 | 0.73 (0.58, 0.92) | NA |  |
 Female | 1 | 0.82 (0.62, 1.08) | NA |  | 1 | 0.78 (0.62, 0.99) | NA |  |
ECOG performance status | Â | Â | Â | 0.255 | Â | Â | Â | 0.938 |
 0 | 1 | 0.90 (0.68, 1.20) | NA |  | 1 | 0.77 (0.61, 0.98) | NA |  |
 1 | 1 | 0.72 (0.56, 0.93) | NA |  | 1 | 0.76 (0.60, 0.96) | NA |  |
Location | Â | Â | Â | 0.290 | Â | Â | Â | 0.127 |
 Asia | 1 | 0.72 (0.56, 0.93) | NA |  | 1 | 0.67 (0.54, 0.84) | NA |  |
 Rest of the world | 1 | 0.89 (0.66, 1.20) | NA |  | 1 | 0.87 (0.68, 1.12) | NA |  |
Disease status | Â | Â | Â | 0.108 | Â | Â | Â | 0.012 |
 Metastatic | 1 | 0.49 (0.27, 0.90) | NA |  | 1 | 0.42 (0.26, 0.68) | NA |  |
 Locally advanced | 1 | 0.83 (0.68, 1.02) | NA |  | 1 | 0.81 (0.68, 0.97) | NA |  |