EGFR突变阴性非小细胞肺癌二、三线治疗的荟萃分析  

Second-and third-line treatment for EGFR mutation-negative non-small-cell lung cancer-meta-analysis

作　　者：杨锁萍 丁为民[1] 李凯[2] 姜兆静[1] 郑燕芳[1] 

机构地区：[1]南方医科大学珠江医院肿瘤中心,广东广州510282 [2]宁波市第二医院介入科,浙江宁波315099

出　　处：《东南大学学报（医学版）》2015年第6期859-867,共9页Journal of Southeast University(Medical Science Edition)

基　　金：国家自然科学基金资助项目(81202073)

摘　　要：目的：比较酪氨酸激酶抑制剂（TKIs）与二线或三线化疗治疗表皮生长因子受体（EGFR）突变阴性的非小细胞肺癌（NSCLC）患者的疗效。方法：检索Pub Med、Cochrane Library、EMBASE、中国知网和美国临床肿瘤学会（ASCO）会议摘要,对符合要求的随机对照试验进行荟萃分析。结果：共纳入7个试验,结局指标包括从随机化分配到疾病进展的时间（PFS）和从方案招募开始到患者死亡的时间（OS）。PFS指标显示,TKIs在统计学上差于化疗（风险比HR=1.34,95%CI为1.08-1.65;P=0.007）;OS指标显示,两者差异无统计学意义（HR=1.07,95%CI为0.92-1.24;P=0.395）。移除2个试验后,PFS指标显示,TKIs仍然差于化疗（风险比HR=1.42,95%CI为1.23-1.63;P=0.000）;OS指标显示,两者差异无统计学意义（HR=1.05,95%CI为0.90-1.23;P=0.536）。所有亚组中厄洛替尼对比化疗差异均无统计学意义。结论：对于EGFR突变阴性且可耐受化疗的NSCLC患者,化疗优于TKIs治疗,但是TKIs可用于体力状况评分差的患者。Objective： To compare the efficacy of TKIs with chemotherapy in second-line or third-line treatment for EGFR mutation- negative NSCLC patients. Methods： Pub Med,Cochrane Library,EMBASE,CNKI and abstracts from the proceedings of ASCO were searched to identify randomized controlled clinical trials. Results： 7randomized controlled trials were identified eligible for meta-analysis. The outcomes of treatment efficacy included PFS and OS. TKIs were statistically significant inferior to chemotherapy in PFS（ hazard ratio（ HR） = 1. 34,95%confidence interval（ CI） = 1. 08- 1. 65; P = 0. 007）. However,no statistically significant difference in OS was found（ HR = 1. 07,95% CI = 0. 92- 1. 24; P = 0. 395）. After removing two trials,the results were not obviously different for both PFS（ HR = 1. 42,95% CI = 1. 23- 1. 63; P = 0. 000） and OS（ HR = 1. 05,95% CI = 0. 90 –1. 23; P = 0. 536）. Erlotinib was not statistically significantly different from chemotherapy in very subgroup.Conclusion： For EGFR mutation-negative NSCLC patients,chemotherapy should take precedence over TKIs for those who can tolerant chemotherapy,while TKIs can be options for patients with poor performance status.

关 键 词：非小细胞肺癌 吉非替尼 厄洛替尼 荟萃分析 

分 类 号：R734.2[医药卫生—肿瘤]