吉西他滨联合铂类与其他含铂方案治疗非小细胞肺癌的Meta分析

Gemcitabine Plus Platinum Chemotherapy Compared with Other Platinum Containing Regimens in Advanced Non-small-cell Lung Cancer: a Meta-analysis of Survival Outcomes

关键词:  晚期非小细胞肺癌  吉西他滨  长春瑞滨  紫杉醇  顺铂  卡铂  Meta分析

Key words:  advanced non-small-cell lung cancer  gemcitabine  vinorelbine  paclitaxel  cisplatin  carboplatin  Meta analysis

摘要:

目的 系统评价铂类联合吉西他滨、长春瑞滨或紫杉醇3种一线化疗方案治疗晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法 检索PubMed(1995—2013)和中国期刊全文数据库(1995—2013)，对符合纳入标准的研究，采用RevMan 5.0 软件进行Meta分析。结果 共纳入8篇国外和15篇国内随机对照临床试验。GP方案与NP方案相比，有效率等同，一年生存率高于NP方案， P =0.03，95%CI=1.03~1.84(国外RCT分析)，Ⅲ~Ⅳ度白细胞减少发生率低于NP方案， P <0.01，95%CI=0.33~0.54；Ⅲ~Ⅳ度恶心、呕吐的发生率亦低于NP方案， P =0.006，95%CI=0.21~0.77(国内RCT分析)。GP方案与TP方案相比，疗效差异无统计学意义( P =0.66， P =0.11)，不良反应国内外分析结果差别较大。结论 种族不同可能是含铂方案临床治疗效果差异的原因，提示我国临床医师应慎重选择化疗方案。

Abstract:

OBJECTIVE To evaluate the treatment effect of gemcitabine plus platinum agent and compare the combination to vinorelbine or paclitaxel as ?rst-line regimens for advanced non-small-cell lung cancer(NSCLC). METHODS Published data from PubMed, CNKI was collected and investigated. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analyses. RESULTS Data from 23 randomized trials(8 from abroad, 15 from domestic) were included in a meta-analysis of time-to-event outcomes. Equivalent effective rata, higher 1-year survival rate from overseas data(P=0.03, 95%CI=1.03-1.84) and lower Ⅲ-Ⅳ leucocytopenia rate( P <0.01, 95%CI=0.33-0.54) in GP regimens were observed compared with NP regimens. There was no statistical difference( P =0.66, P =0.11) on efficacy and a significant difference on toxicity between GP regimens and TP regimens.CONCLUSION The differences of rates can possible cause different effect for patients treated by containing platinum regimens, should be an important factor when our country’s doctor choose regimen.