抑制环氧化酶-2信号通路治疗晚期非小细胞肺癌疗效与安全性的系统评价与Meta分析  

Efficacy and Safety of Cyclooxygenase-2 Signal Pathway Inhibition in Treating Advanced Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis

作　　者：邓汉宇 王运仓[1] 王玺 范树才 林一丹[1] 

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]四川大学华西临床医学院,成都610041

出　　处：《中国胸心血管外科临床杂志》2016年第2期160-167,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(31071210N;30400440)~~

摘　　要：目的系统评价抑制环氧化酶-2(cyclooxygenase-2,COX-2)信号通路治疗晚期非小细胞肺癌的疗效和安全性。方法计算机检索PubMed、EMbase、Cochrane Library、American Society of Clinical Oncology(ASCO)、CNKI、万方等数据库,检索时间从每个数据库建库至2015年6月,纳入有关选择性COX-2抑制剂治疗晚期非小细胞肺癌的临床随机对照研究(RCT),采用Jadad评分标准评价纳入研究质量,运用Stata12.0软件进行Meta分析。结果共纳入12个RCT,包括3种COX-2抑制剂,1 828例患者。其中高质量文献8篇,低质量文献有4篇。Meta分析结果显示,抑制COX-2信号通路可以显著提高患者治疗的总体反应率[RR=1.27,95%CI(1.10,1.46),P=0.001],但目前的数据尚不能说明抑制COX-2信号通路可以提高晚期非小细胞肺癌患者的1年生存率[RR=1.08,95%CI=(0.90,1.24),P=0.29],延长无进展生存时间[HR=0.93,95%CI(0.81,1.08),P=0.334]或总体生存时间[HR=0.95,95%CI=0.84,1.08),P=0.461]。同时,COX-2抑制剂可能会增加非小细胞肺癌患者血小板降低[RR=1.28,95%CI=(1.03,1.85),P=0.03]的发生风险。结论抑制COX-2信号通路可以显著提高晚期非小细胞肺癌患者的治疗反应率,且患者整体耐受良好,但能否提高远期生存尚有待进一步的临床研究验证。Objective To systemically evaluate the efficacy and safety of cyclooxygenase-2 （COX-2） signal pathway inhibition in treating advanced non-small cell lung cancer （NSCLC）. Methods A systematic literature search in PubMed, EMbase, Cochrane Library, ASCO databases, CNKI and Wanfang database was conducted to identify relevant randomized controlled trials （RCTs） from the time of database establishment to June 2015. RCTs of COX-2 inhibitors treating advanced NSCLC were included. We assessed the methodology quality of the included studies by using Jadad＇s scale, and performed this meta-analysis by using statal2.0 software. Results Twelve RCTs involving three different COX-2 inhibitors with a total of 1 828 patients were identified including 8 studies of high quality and 4 studies of low quality. We found that COX-2 signal pathway inhibition could significantly increase overall response rate at RR= 1.27 with 95%CI1.10 to 1.46 （P=0.001）. While our present data could not confirm the efficacy of COX-2 inhibitors in improving progression-free survival （PFS） at HR=0.93 with 95%CI0.81 to 1.08 （P=0.334）, overall survival （OS） at HR=0.95 with 95%CI0.84 to 1.08 （P=0.461）, or one-year survival rate at RR=I.08 with 95%CI0.90 to 1.24 （P=0.29）. As for toxicities, only increased risk of thrombocytopenia at RR= 1.28 with 95%CI 1.03 to 1.85 （P=0.03） was observed in the patients treated with COX-2 inhibitors. Conclusion COX-2 signal pathway inhibition is effective in improving the overall response rate of the patients with advanced NSCLC, and is well tolerated. Whether COX-2 signal pathway inhibition is effective in improving long-term survival of the patients with advanced NSCLC still needs to be confirmed via further clinical trials.

关 键 词：环氧化酶-2抑制剂 非小细胞肺癌 系统评价/META分析 

分 类 号：R734.2[医药卫生—肿瘤]