Abstract
BACKGROUND: This study systematically assesses the efficacy of immunotherapy as a first-line treatment for patients with non-small-cell lung cancer (NSCLC) and bone metastases who lack driver gene mutations. This analysis draws on data from randomized controlled trials to support individualized treatment strategies. METHODS: Randomized controlled trials published up to October 1, 2024, were retrieved from PubMed, EMBASE, the Cochrane Library, and the Web of Science. Statistical analyses were conducted using RevMan 5.4 and STATA 17.0, with the results presented in forest plots. Progression-free survival (PFS) and overall survival (OS) were analyzed using hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024604768). RESULTS: Meta-analysis demonstrated a significant improvement in OS and PFS for patients with bone metastases receiving immunotherapy (OS: HR: 0.81, 95% CI: 0.71-0.92; PFS: HR: 0.78, 95% CI: 0.62-0.98). Although the survival benefit of immunotherapy was lower in patients with bone metastases than in those without, it was superior to chemotherapy. CONCLUSIONS: Among patients with driver gene-negative NSCLC and bone metastases, immunotherapy significantly improved OS and PFS, thus supporting its role as an effective first-line treatment. Further large-scale trials are recommended to enhance treatment precision and validate these findings.