Abstract
BACKGROUND: Emotional distress (ED) is associated with worse survival outcomes in patients with melanoma and non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). However, several preclinical studies suggest the association between stress and cancer treatment extends beyond ICIs alone. OBJECTIVES: To systematically evaluate the relationship between ED and NSCLC patient prognosis. DESIGN: This study is an individual patient data (IPD) meta-analysis. DATA SOURCES AND METHODS: Relevant studies were identified from the PubMed, Web of Science, The Cochrane Library, Embase, and Vivli databases to obtain IPD up to February 2025. The hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to estimate the association between ED and patient prognosis. Subgroup analysis was conducted based on patient treatment methods. RESULTS: Kaplan-Meier analysis shows that compared with patients without ED, patients with ED had worse survival outcomes, regardless of ICIs or chemotherapy (CT) (HR of overall survival (OS), 1.21 (1.11-1.33), p = 0.01; hazard ratio of progression-free survival (PFS), 1.19 (1.07-1.31), p = 0.01). IPD meta-analysis also supported results above (HR of OS, 1.18, 95% CI, 1.07-1.30; HR of PFS, 1.15, 95% CI, 1.03-1.28). CONCLUSION: Our research suggests that ED is only a prognostic biomarker in NSCLC, rather than a predictive biomarker for ICIs.