厄洛替尼治疗非小细胞肺癌并发贫血的Meta分析  

Anemia of erlotinib for advanced non-small cell lung cancer:A Meta analysis of randomized controlled trials

作　　者：马虎[1,2] 周建国[1] 柏玉举[1] 张钰[1] 王菲[1] 王怡[1] 吕水萍 

机构地区：[1]遵义医学院附属医院肿瘤医院胸部肿瘤科,贵州遵义563000 [2]遵义医学院转化医学中心,贵州遵义563000

出　　处：《中华肿瘤防治杂志》2016年第1期49-55,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81360351);贵州省科技厅攻关项目(黔科字[2013]3003);遵义医学院博士启动基金(F-577);遵义医学院研究生社会实践项目(zyyis2015004);贵州省科技厅及遵义医学院;遵义市科技局联合基金重点项目(黔科合J字LKZ[2013]07号);贵州省高层次创新型人才培养项目

摘　　要：目的NCCN指南推荐厄洛替尼作为伴有EGFR突变的晚期非小细胞肺癌（non-smallcell1ungcancer，NSCLC）一线治疗的标准方案，但厄洛替尼与贫血发生的相关性无相应的系统评价参考，拟通过系统评价分析厄洛替尼治疗NSCLC并发贫血的风险。方法收集2005-01—2015—06Cochrane图书馆、PubMed、Embase、webofscience、中国学术期刊全文数据库、万方数据库和中国生物医学文献数据库等，纳入厄洛替尼治疗NSCLC并发贫血的随机对照试验（randomizedcontrolledtrials，RCTs）。2名评价者独立评价纳入研究的质量、提取资料并交叉核对，同质研究采用Stata12．0软件进行Meta分析，使用SAs9．0软件进行效能检验。结果共纳入15项研究，包括17个随机对照试验，干预组2380例，对照组2381例。Meta分析结果显示，厄洛替尼单药相比较于单纯化疗而言，所有等级尤其三级以上贫血并发症均明显减少，三级以上相对危险度（riskratio，RR）为0．57，95％CI为0．40～0．81，P=0．002；所有等级RR为0．47，95％CI为0．25～0．89，P=0．015。厄洛替尼联合化疗组，所有等级贫血并发症差异无统计学意义，三级以上RR为1．10，95％CI为0．75～1．63，P=0．626；所有等级RR为0．95，95％CI为0．67～1．35，P=0．764。效能检验结果显示，三级以上贫血并发症的效能为92．0％，总的贫血并发症的效能为10．0％。结论与化疗相比，厄洛替尼单独用药治疗NSCLC能够明显减少贫血并发症的风险；厄洛替尼联合化疗不能降低并发贫血的风险。OBJECTIVE Erlotinib is the first-generation EGFR-TKIs,the National Comprehensive Cancer Network （NCCN） guidelines recommend it as a first-line agent in patients with sensitizing EGFR mutations. However,the Meta-a- nalysis,which assessed the anemia of erlotinib plus chemotherapy （CT） or erlotinib alone for advanced NSCLC was not found. The aim of this study is to systematically evaluate the anemia of erlotinib plus chemotherapy or alone compared with conventional CT for advanced non-small cell lung cancer and to provide references for further clinical practice and re- search. METHODS Relevant randomized controlled trials （RCTs） were obtained from the Cochrane library,PubMed, Embase,Web of Science, CBM, CNKI and Wan Fang databases. The literature was screened, data were extracted and methodological quality of the included studies was assessed. The data included in the study was analyzed using STATA 12.0 software. The power analysis was calculated by SAS 9.0. RESULTS A total of 17 RCTs were included. The recta- analysis showed that compared with CT,erlotinib alone decreased risks of all grades anemia （RR=0.47, 95 % CI： 0.25, 0. 89,P=0. 015） ,especially grade ≥3 anemia （RR=0.57,95%CI：0.40,0.81 ,P=0. 002）. But there were no significantdecreases in the risk of all grades anemia （RR=0.95,95%CI： 0. 67,1. 35,P〈0. 764） and grade ≥ 3（RR=1. 10,95%CI： 0.75,1.63,P=0. 626） anemia in erlotinib combined with CT group. The power analysis suggested that a power of 92.0% was determined to detect an RR of 0.88 for grade ≥3 anemia,and 10.0% for an RR of 0.70 for all grades anemia. CONCLUSION This pooled analysis suggests that erlotinib alone for advanced NSCLC is associated with decreased risk of anemia.

关 键 词：非小细胞肺癌 厄洛替尼 化疗 META分析 效能检验 

分 类 号：R734.2[医药卫生—肿瘤]