吉西他滨联合铂类两药方案与单药方案对非小细胞肺癌治疗比较的meta分析  

A meta Analysis of Gemcitabine plus Platinum Chemotherapy Compared with Single-agent Chemotherapy in the Treatment of Non-small Cell Lung Cancer

作　　者：苟云久[1,2] 张玲娟[2,3] 杨启梅[2,3] 张蓉芳[2,3] 郭慧玲[2,3] 姜雷[2] 杨克虎[2] 田金徽[2] 

机构地区：[1]兰州大学第二医院心胸外科,兰州730000 [2]兰州大学循证医学中心,兰州730000 [3]兰州大学第二临床医学院,兰州730000

出　　处：《中国肺癌杂志》2010年第3期216-223,共8页Chinese Journal of Lung Cancer

基　　金：兰州大学循证医学中心循证医学本科生教学创新基金(No.2008LDEBM-B)资助~~

摘　　要：背景与目的吉西他滨联合铂类治疗晚期非小细胞肺癌的疗效是否优于单用吉西他滨或铂类尚存在争议,本研究对吉西他滨联合铂类治疗晚期非小细胞肺癌的有效性和安全性进行meta分析。方法计算机检索VIP、CBM、CNKI、The Cochrane Library、PUBMED和EMBASE等数据库,同时追查纳入文献的参考文献和与本领域专家、通讯作者等联系以获取以上检索尚未发现的相关信息。收集吉西他滨联合铂类治疗晚期非小细胞肺癌的随机对照试验(RCT),根据Cochrane Handbook5.0质量评价标准评价,用RevMan5.0软件进行统计学分析。结果共纳入4个随机对照试验(984名研究对象)的meta分析结果显示,吉西他滨联合铂类在有效率(OR=3.29,95%CI:1.79-6.05,P=0.0001)、2年生存率(OR=3.22,95%CI:1.45-7.12,P=0.004)等方面与单用吉西他滨的差异有统计学意义,但联合用药组的不良反应发生率增加明显,以3/4级血小板减少发生率增加最为明显(RR=8.16,95%CI:1.71-39.07,P=0.009);吉西他滨联合铂类在有效率(OR=3.51,95%CI:2.20-5.60,P<0.01)、1年生存率(OR=1.67,95%CI:1.16-2.41,P=0.006)等方面与单用顺铂的差异有统计学意义,联合用药组的不良反应发生率增加明显,以3/4级血小板减少发生率增加最为明显(OR=28.55,95%CI:14.06-57.04,P<0.01)。结论与单药组相比,联合组可明显提高非小细胞肺癌患者的有效率和生存率,同时增加了毒副反应发生率。上述结果尚需高质量随机对照试验进一步证实。Background and objective Whether gemcitabine plus platinum chemotherapy is superior to gemcitabine or platinum single-agent chemotherapy for patients with non-small cell lung cancer （NSCLC） is still in dispute, and the aim of this study is to evaluate the efficacy and safety of gemcitabine combining platinum chemotherapy for patients with NSCLC. Methods We searched relevant randomized controlled trials （RCTs） from VIP, CBM, CNKI, the Cochrane library, PUBMED and EMBASE. We traced the related references and experts in this field and communicated with other authors to obtain the information that has not been found. We made quality assessment of qualified RCTs assessed by the exclusion and inclusion criteria and used RevMan 5.0 provided by the Cochrane Collaboration to perform meta-analysis. Results Four RCTs were eligible and included 984 patients. Meta analysis results suggested that： compared with gecitabine single-agent chemotherapy, the combination had a statistically significant benefit in increasing the response rate （OR=3.29, 95%CI： 1.79-6.05, P=0.000 1） and 2-year survival rate （OR=3.22, 95%CI： 1.45-7.12, P=0.004） while increased the risk of the incidence of adverse reactions, especially the grade 3-4 thrombocytopenia （RR=8.16, 95%CI： 1.71-39.07, P=0.009）; compared with cisplatin single-agent chemotherapy, the combination had a statistically significant benefit in increasing the response rate （OR=3.51, 95%CI： 2.20-5.60, P〈0.01） and 1-year survival rate （OR=1.67, 95%CI： 1.16-2.41, P=0.006） while increased the risk of the incidence of adversereactions, especially the grade 3-4 thrombocytopenia （OR=28.55, 95%CI： 14.06-57.04, P〈0.01）. Conclusion Compared with single-agent chemotherapy, the combining can significantly improve the efficiency and survival rate while increase the toxicity rare. The results still need to be proved by high quality RCTs.

关 键 词：肺肿瘤 吉西他滨 META分析 

分 类 号：R734.2[医药卫生—肿瘤]