吉非替尼联合放疗治疗非小细胞肺癌脑转移临床疗效Meta分析  

Efficacy of Gefitinib combined with brain radiotherapy for patients with brain metastases from non-small cell lung cancer:A Meta analysis

作　　者：刘园园[1] 张学飞[1] 冯刚玲[1] 魏猛[1] 徐孟川[1] 李述刚[1] 庞丽娟[2] 

机构地区：[1]石河子大学医学院预防医学系,新疆石河子832002 [2]石河子大学医学院病理系,新疆石河子832002

出　　处：《中华肿瘤防治杂志》2016年第2期121-127,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：新疆生产建设兵团重大公共卫生专项(2100409)

摘　　要：目的吉非替尼联合放疗治疗非小细胞肺癌（non-small cell lung cancer,NSCLC）脑转移患者的临床疗效尚不确定,本研究通过吉非替尼联合放疗对NSCLC脑转移患者的临床疗效进行Meta分析,进而为临床应用提供科学依据。方法 2位研究者对Cochrane、PubMed、EMbase、Sciencedirect、CNKI、万方和维普等数据库检索文献至2015-04,并进行文献筛选、提取资料和交叉核对。结局指标包括完全缓解（complete response,CR）、部分缓解（partial response,PR）、病变稳定（stable disease,SD）、疾病进展（progressive disease,PD）、总有效率（overall response rate,ORR）、疾病控制率（disease control rate,DCR）、疾病进展时间（progression-free survival,PFS）、中位生存时间（median survival time,MST）和不良反应等。纳入研究的结果采用RevMan 5.2软件和Stata 12.0软件进行Meta分析。结果共纳入11篇临床研究,包括626例病例。吉非替尼联合放疗治疗NSCLC脑转移患者的颅内病灶CR（OR=3.06,95%CI为1.35～6.92,P〈0.01）、PR（OR=1.69,95%CI为1.10～2.60,P=0.02）、ORR（OR=2.46,95%CI为1.71～3.54,P〈0.01）和DCR（OR=2.97,95%CI为1.99～4.42,P〈0.01）均明显高于单纯治疗;而PD（OR=0.35,95%CI为0.23～0.52,P〈0.01）低于单纯治疗;且SD在联合治疗与单纯治疗之间差异无统计学意义,P=0.63。另外,吉非替尼联合放疗的PFS和MST分别为8.72和17.22个月,明显高于单纯治疗的6.17和12.35个月,P〈0.01;且吉非替尼联合放疗与单纯治疗的不良反应差异无统计学意义,P〉0.05。结论吉非替尼联合放疗对非小细胞肺癌脑转移患者的颅内病灶具有较好的临床疗效。OBJECTIVE Currently,there is no consensus in the effect of gefitinib combined with whole-brain radiation therapy（WBRT）in patients with brain metastases from non-small cell lung cancers（NSCLC）.In this study,we evaluated the efficacy of the combined therapy by Meta analysis and provided scientific basis for clinical study.METHODSTwo reviewers searched the Cochrane,PubMed,EMbase,Sciencedirect,CNKI,WANFANG,and VIP databases for studies.Then they screened,evaluated the study and extracted the data.End-points included complete response（CR）,partial response（PR）,stable disease（SD）,progressive disease（PD）,overall response rate（ORR）,disease control rate（DCR）,progression-free survival（PFS）,median survival time（MST）and adverse events.Meta-analyses were performedby RevMan 5.2and Stata 12.0softwares.RESULTS This study included 11 clinical studies and 626 patients.Compared to monotherapy,gefitinib with WBRT resulted in higher CR（OR=3.06,95%CI：1.35-6.92,P〈0.01）and PR（OR=1.69,95%CI：1.10-2.60,P=0.02）rates,ORR（OR=2.46,95%CI：1.71-3.54,P〈0.01）,and DCR（OR=2.97,95%CI：1.99-4.42,P〈0.01）,and lower PD rates（OR=0.35,95%CI：0.23-0.52,P〈0.01）for NSCLC patients with brain metastases.However,there was no significant difference for SD between combination therapy and monotherapy（P=0.63）.Additionally,combination therapy resulted in better PFS（8.72 months）and MST（17.22 months）than monotherapy（6.17 and 12.35 months,P〈0.01,respectively）without significant differences in adverse events（P〈0.05）.CONCLUSION Gefitinib combined with WBRT is more efficacious than monotherapy for brain metastases from NSCLC.

关 键 词：非小细胞肺癌 吉非替尼 脑转移 META分析 

分 类 号：R734.2[医药卫生—肿瘤]