摘要
背景与目的铂类联合第三代化疗药物的双药化疗方案已被美国临床肿瘤(ASCO)和美国国家综合癌症网(NCCN)推荐为进展期非小细胞肺癌(non-small cell lung cancer,NSCLC)的标准一线治疗方案。本研究旨在用meta分析评价铂类联合紫杉类(Platinum plus Taxanes,TP)治疗进展期NSCLC的疗效和毒副作用。方法在CENTRAL、EMBASE、PubMed和中国生物医学文献数据库中检索铂类联合紫杉类或其他第三代化疗药物治疗晚期NSCLC的随机临床试验。将符合入选标准的文献纳入meta分析,并根据Jadad评分法进行质量评分。结果9篇文献(共4703例患者),被纳入meta分析,TP方案组与铂类联合其他第三代化疗药物组的缓解率和1年生存率无明显差异(RR合并=1.00,95%CI:0.91-1.11,P=0.95;RR合并=0.98,95%CI:0.84-1.15,P=0.83);TP方案组3-4级白细胞减少、中性粒细胞减低、贫血及消化道症状如恶心、呕吐均明显低于铂类联合其他第三代化疗药物组。亚组分析显示:TP方案和铂类联合长春瑞滨(Platinum plus Vinorelbine,NP)方案或铂类联合吉西他滨(Platinum plus Gemcitabine,GP)方案的缓解率和1年生存率无明显差异;TP方案3-4级白细胞减少、中性粒细胞减低、贫血的发生率明显低于NP方案,TP方案3-4级贫血、血小板减少的发生率明显低于GP方案。结论铂类联合紫杉类或其他第三代化疗药物治疗进展期NSCLC的疗效相似,但在毒副反应方面差异明显,为选择个体化化疗方案提供了重要的依据。
Background and objective The platinum-based plus a third-generation agent doublet chemotherapy regimen has been recommended as the standard first-line chemotherapy for advanced NSCLC by ASCO and NCCN. Tbis study was aimed to evaluate the clinical efficacy and side effects of the Platinum plus Taxanes or other novel agent. Methods The databases PubMed, CENTRAL, EMBASE and Chinese Biomedical Literature database were retrieved by using the key words ＂non small cell lung cancer＂ or ＂Carcinoma, Non Small Cell Lung＂ so as to search the studies about the randomized controlled clinical trials, which compared Platinum plus Taxanes with Platinum plus other novel agents. A meta-analysis was conducted and the quality scores were evaluated according to the improved Jadad＇s score. Results Nine randomized controlled clinical trials with 4 703 patients were included. The overall response rate and 1 year survival rate of the two groups were not significantly different （RR= 1.00, 95%CI： 0.91-1.11, P=0.95; RR=0.98, 9S%CI： 0.8441.15, P=0.83）. The incidence rate of grade 3-4 leukopenia, neutropenia, anemia, nausea and vomiting in TP is much lower than that in platinum plus other novel agent. Sub-group analysis showed that the overall response rate and 1 year survival rate of TP aren＇t statistically different from NP or GE The incidence rate of grade 3-4 leukopenia, neutropenia and anemia in TP is statistically lower than that in NP. The incidence rate of grade 3-4 anemia and thrombocytopenia in TP is statistically lower than that in GP. Conclusion The dinical efficacy of TP and platinum plus other novel agent is quite similar, but quite different from each other in side effects, which provides important evidence on selecting individual chemotherapy regimen.
出处
《中国肺癌杂志》
CAS
2009年第8期868-874,共7页
Chinese Journal of Lung Cancer
