电视辅助胸腔镜手术和体部立体定向放疗治疗早期非小细胞肺癌的临床疗效比较  

Comparison of Clinical Outcomes of VATS and SBRT in the Treatment of NSCLC

作　　者：王建东[1] 左占杰 张洪波[1] 李伟[1] 王坤峰[1] 

机构地区：[1]武警北京总队医院胸部肿瘤治疗中心,北京100027

出　　处：《中国肺癌杂志》2016年第3期136-146,共11页Chinese Journal of Lung Cancer

摘　　要：背景与目的越来越多的胸科医生选择电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)来治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)。目前,仍然没有随机试验来比较VATS和体部立体定向放疗(stereotactic body radiotherapy,SBRT)的临床疗效。为此,在本meta分析中,我们比较了电视辅助胸腔镜手术和体部立体定向放疗在治疗早期NSCLC患者过程中的疗效,以期为今后对此两种疗法的选择提供参考。方法系统地检索5个主要的医学期刊数据库:中国知网、维普网、PubMed、Embase和ISI web of science,收集时间涵盖2010年1月-2016年2月的应用电视辅助胸腔镜手术和体部立体定向放疗治疗早期NSCLC的所有文献。最后,纳入了拥有足够患者数量和放疗剂量的原创中英文研究成果。在校正了中位年龄和可手术患者人数之后,应用多变量随机效应模型比较了电视辅助胸腔镜手术和体部立体定向放疗治疗后早期NSCLC患者的总生存率和无疾病生存率。结果纳入相同时期的14个电视辅助胸腔镜手术研究成果(包含3,482个患者)和19个体部立体定向放疗研究成果(包含3,997个患者)。VATS组中位年龄和随访时间分别为64岁和43.4个月,SBRT组中位年龄和随访时间分别为74岁和29.5个月。VATS组校正前1年、2年、3年、5年平均总生存率分别为93.5%、84.9%、77.0%、76.3%。SBRT组校正前1年、2年、3年、5年平均总生存率分别为89.0%、73.3%、59.0%、36.7%。VATS组校正前1年、2年、3年、5年平均无病生存率分别为93.6%、88.6%、85.6%、75.6%。SBRT组校正前1年、2年、3年、5年平均无病生存率分别为79.3%、72.1%、64.9%、58.9%。然而,以中位年龄和可手术程度进行校正之后,预期VATS组1年、2年、3年、5年总生存率为94%、92%、84%、71%,预期SBRT组1年、2年、3年、5年总生存率为98%、95%、87%、83%。预期VATS组1年、2年、3年、5年无病生存率为97%、94%、Background and objective More and more chest physicians chose video-assisted thoracoscopic surgery（VATS） to treat early stage non-small cell lung cancer（NSCLC）. In recent years, there is still lack of a random trial comparing the clinical outcomes of VATS and stereotactic body radiotherapy（SBRT） in treating NSCLC. To provide a reference for the choice between VATS and SBRT, in the current meta-analysis, we compared the clinical outcomes of these two therapies in treating NSCLC. Methods Five major medical databases, CNKI, CPVIP（http：//www.cqvip.com/）, Pub Med, Embase, and ISI web of science were systematically searched to identify all studies from January 2010 to February 2016 on VATS and SBRT therapies. Finally, original English or Chinese publications of stage I and II NSCLC with adequate patients and adequate SBRT doses were enrolled. A multivariate random effects model was used to perform a meta-analysis to compare overall survival and disease free survival between VATS and SBRT while adjusting for median age and operable patient numbers. Results Fourteen VATS studies（included 3,482 patients） and nineteen SBRT studies（included 3,997 patients） published in the same period were eligible. The median age and follow-up duration were 64 years and 43.4 months for VATS patients and 74 years and 29.5 months for SBRT patients, respectively. The mean unadjusted overall survival rates at 1, 2, 3, and 5 years with VATS were93.5%, 84.9%, 77.0% and 76.3% compared to 89.0% 73.3% 59.0% and 36.7% with SBRT. The mean unadjusted disease free survival rates at 1, 2, 3, and 5 years with VATS were 93.6%, 88.6%, 85.6% and 75.6% compared to 79.3%, 72.1%, 64.9% and 58.9% with SBRT. While, after adjusted for proportion of operable patients and median age, the estimate overall survival rates at 1, 2, 3, and 5 years with VATS were 94%, 92%, 84% and 71% compared to 98%, 95%, 87% and 83% with SBRT. And the estimate disease free survival rates at 1, 2, 3, and 5 years with VATS were 97%, 94%, 85% and 75% compared to

关 键 词：肺肿瘤 电视辅助胸腔镜手术 体部立体定向放疗 生存率 Meta分析 

分 类 号：R734.2[医药卫生—肿瘤]