EGFR抑制剂治疗EGFR突变型晚期非小细胞肺癌的Meta分析  

Meta analysis on advanced NSCLC with EGFR mutations treated randomly by EGFR inhibitors

作　　者：张蓉[1] 陈薇雅[1] 甘洁民[1] 赵虎[1] 顾兆祥[1] 

机构地区：[1]复旦大学附属华东医院,上海200040

出　　处：《检验医学》2013年第6期506-510,515,共6页Laboratory Medicine

摘　　要：目的利用Meta分析评估表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂(TKIs)一线治疗晚期EGFR突变型非小细胞肺癌(NSCLC)的疗效。方法在PubMed和Embase文献数据库中检索2004年1月至2012年4月发表的相关文献。制定纳入标准对文献进行筛选以保证纳入研究的同质性。由2名评价者独立评价所纳入研究的质量,提取资料并交叉核对。符合标准的研究采用RevMan5.1软件进行Meta分析。对总有效率(ORR)选择相对危险度(RR)作为效应尺度指标,对无进展生存时间(PFS)和总生存时间(OS)计算风险比(HR),同时计算95%可信区间(CI)。结果 6个Ⅲ期随机对照试验符合全部纳入标准,含1 030例NSCLC患者。Meta分析显示,接受EGFR-TKIs治疗患者与接受化疗的患者相比具有较高的ORR(RR=2.19,95%CI=1.68～2.15,P<0.000 01)和较长的PFS(HR=0.43,95%CI=0.35～0.52,P<0.000 01);而OS差异无统计学意义(HR=0.98,95%CI=0.81～1.18,P=0.80)。结论 EGFR-TKIs一线治疗晚期NSCLC是有效的。为预测一线使用EGFR-TKIs的疗效,应对晚期NSCLC患者进行EGFR基因突变检测。Objective To use Meta analysis to evaluate the efficacy of epidermal growth factor receptor（ EGFR）- tyrosine kinase inhibitors （TKIs） as first-line treatment for advanced non-small cell lung cancer （NSCLC） with EGFR mutations. Methods Relevant literatures were searched through PubMed and Embase databases from January 2004 to April 2012. The implement standards for literature-selection were used to ensure the homogeneity of research. Two reviewers evaluated independently the quality of the included studies and extracted the data. Meta analysis was performed by RevMan 5.1 software. Risk ratio （RR） as efficacy index was chosen by overall response rate （ ORR）, and hazard ratios （HR） were calculated by progression-free survival （PFS） and overall survival （OS） times. The 95% confidence interval（CI） was calculated simultaneously. Results Six phase llI randomly controlled trials were included for a total of 1 030 patients with NSCLS. This Meta analysis showed a statistical significance in ORR （ RR = 2. 19, 95% CI= 1.68-2.15, P〈 0. 000 01） and PFS （HR = 0.43, 95%CI = 0.35-0.52, P〈 0.00001） for patients who received EGFR-TKIs compared with patients who received chemotherapy. No statistical significance was observed in OS （ HR = 0.98, 95% CI = 0.81-1.18, P = 0.80）. Conclusions EGFR-TKIs are effective as first-line treatment for advanced NSCLC. The EGFR mutation testing should be made for advanced NSCLC patients to predict efficacy to first-line therapy with EGFR-TKIs.

关 键 词：表皮生长因子受体 突变 非小细胞肺癌 酪氨酸激酶抑制剂 META分析 

分 类 号：R446.61[医药卫生—诊断学]