非小细胞肺癌紫杉醇类联合顺铂同步或序贯放化疗对比的Meta分析  

Docetaxel or Pacfitaxe plus Cisplatin chemotherapy with concurrent radiotherapy versus sequential radiotherapy for non-small cell lung cancer:A Meta analysis

作　　者：任维维[1,2] 米登海[1,2,3] 李征[1,2] 田金徽[1] 杨克虎[1,2] 张质钢[1,2] 

机构地区：[1]兰州大学循证医学中心,甘肃兰州730000 [2]兰州大学第一临床医学院普外科,甘肃兰州730000 [3]甘肃省第二人民医院肿瘤科,甘肃兰州730000

出　　处：《中华肿瘤防治杂志》2013年第5期377-382,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：甘肃省卫生行业科研计划(GSWST09-06);甘肃省自然科学研究基金(1010RJZA162);兰州大学循证医学中心循证医学研究生创新基金(2010LDEBM-A)

摘　　要：目的:探讨紫杉醇类联合顺铂同步放化疗对比序贯放化疗的临床疗效和安全性。方法:通过Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国学术期刊全文数据库、中国科技期刊数据库和数字化期刊全文数据库,检索时限为自各数据库建库起至2012-03-28,全面检索多西紫杉醇或紫杉醇联合顺铂同步放化疗对比序贯放化疗治疗非小细胞肺癌的随机对照试验(RCT),按纳入排除标准筛选文献、提取资料和质量评价后,采用Rev Man 5.1软件进行Meta分析。结果:纳入18个RCT,共1 385例患者。Meta分析结果显示,在近期疗效方面,多西紫杉醇(OR合并=2.99,95%CI为2.15～4.16,P<0.01)或紫杉醇(OR合并=2.79,95%CI为2.02～3.85,P<0.01)联合顺铂同步放化疗疗法对比序贯放化疗疗法,差异有统计学意义。在1(OR合并=2.07,95%CI为1.45～2.94,P=0.000 1)、2(OR合并=2.00,95%CI为1.31～3.04,P=0.001 0)和3年(OR合并=3.25,95%CI为1.87～5.68,P=0.000 1)生存率方面,紫杉醇联合顺铂同步放化疗疗法对比序贯放化疗疗法,差异有统计学意义。多西紫杉醇联合顺铂同步放化疗疗法能提高1年生存率,OR合并=1.85,95%CI为1.32～2.60,P=0.000 4。在安全性方面,紫杉醇联合顺铂同步放化疗疗法增加放射性肺炎、骨髓抑制和脱发不良反应,P<0.05;多西紫杉醇联合顺铂同步放化疗疗法增加放射性肺炎、放射性食管炎和白细胞降低不良反应,P<0.05。结论:多西紫杉醇或紫杉醇联合顺铂同步放化疗疗法治疗非小细胞肺癌,近期疗效优于序贯放化疗疗法,并能提高患者的生存率,但有增加不良反应的趋势,在选择治疗方案时需要权衡利弊综合考虑。OBJECTIVE：To evaluate the effectiveness and safety of docetaxel or pacfitaxe plus cisplatin chemothera- py with concurrent radiotherapy versus sequential radiotherapy for non-small cell lung cancer. METHODS：We searched the randomized controlled clinical trial （RCT） of docetaxel or pacfitaxe plus cisplatin chemotherapy with concurrent radiother- apy versus sequential radiotherapy for non-small cell lung cancer in the cochrane library,PubMed, EMbase,CBM, CNKI, VIP and Wan Fang database from inception to March 28,2012. The methodological quality of the included studies was e- valuated according to the cochrane assessment,and the recta-analysis was conducted by RevMan 5.1 soft ware. RESULTS： A total of 18 RCTs involving 1 385 patients were included. The recta-analysis showed that the total effective rate of thetest group received concurrent radiotherapy was higher than that in the control group received sequential radiotherapy （OR-2.99,95%CI：2.15--4.16,P〈0.01） and（OR=2.79,95%CI：2.02--3.85,P〈0.01）. The OR and 95%C1 of the test group received pacfitaxe plus cisplatin chemotherapy with concurrent radiotherapy inl, 2,3-year survival rates were （OR--2.07,95% CI：1.45--2.94,P=0.000 1）,（OR=2.00,95%CI..1.31--3.04,P=0.001 0）and（OR=3.25,95%CI： 1.87-- 5.68, P= 0. 000 1 ） and the test group received docetaxel plus cispatin chemotherapy in 1-year survival rate were （OR 1.85,95 % CI： 1. 32--2. 60, P= 0. 000 4）. Significant difference of the pacfitaxe group was found in radiation pneu- monitis,myelosuppression,and hair loss （P〈0.05） and the docetaxel group in radiation pneumonitis,radiation esophagi- tis,leucopenia （P〈0.05）. CONCLUSION：The docetaxel or pacfitaxe plus eisplatin chemotherapy with concurrent radio- therapy versus sequential radiotherapy has beneficial effects in treatment of non-small cell lung cancer and improves st, r- vival rates, but increases toxic and adverse reaction,Treatment options must be individualized and weighed up the pros and cons.

关 键 词：多西紫杉醇 紫杉醇 顺铂 同步放化疗 序贯放化疗 非小细胞肺癌 随机对照试验 META分析 

分 类 号：R734.2[医药卫生—肿瘤]