新辅助化疗对非小细胞肺癌预后影响的Meta分析

Meta-analysis of the Effect of Neoadjuvant Chemotherapy forthe Prognosis of Non-small Cell Lung Cancer

目的应用Meta分析的方法探讨新辅助化疗对非小细胞肺癌预后的影响。材料和方法在MEDLINE、Cochrane图书馆及CBMdisc数据库检索有关非小细胞肺癌新辅助化疗的临床对照研究。分别对入选的研究进行文献评价,最后提取资料进行Meta分析。结果从1994-2004年共有8个研究入选,试验组共1001例,对照组共有964例。分析结果显示新辅助化疗后手术治疗与直接手术治疗相比,死亡风险优势比OR=0.68(95%CI,0.56～0.83),P值等于0.0002,差异有统计学意义。对纳入研究进行分层分析后,研究质量评分≥8分的研究Meta分析结果显示新辅助化疗后手术与直接手术相比,死亡风险优势比OR=0.80(95%CI0.58～1.09),P值等于0.15。研究质量评分小于8分的研究Meta分析结果显示新辅助化疗后手术与直接手术相比,死亡风险优势比OR=0.62(95%CI0.48～0.80),P值等于0.0002。结论非小细胞肺癌新辅助化疗后手术治疗与直接手术治疗比较能否提高患者生存率仍不明确,需要进一步研究。

Objective To evaluate the effects of neoadjuvant chemotherapy for the prognosis of the patients with non-small cell lung cancer by meta-analysis. Material and Method Search all of CCT on neoadjuvant chemotherapy for non-small cell lung cancer in MEDLINE, Cochrane Library, CBM database. A meta-analysis was carried out by collecting information based on inclusion and exclusion criteria from all papers available. Results The meta-analysis included 8 trials.A total of 1 965 patients were included in the analysis(1 001 in the study group and 964 in the control group). There was statistical significant difference in survival between the study group (neoadjuvant chemotherapy plus surgery group)and the control group(surgury group) [odds ratio(OR) 0.68, 95%CI 0.56 to 0.83, P=0.000 2]. After further analysis,there was not statistical significant difference in survival between the study group and the control group among these studies that review scores were more than eight(OR 0.80, 95%CI 0.58 to 1.09, P=0.15). There was statistical significant difference in survival between the study group and the control group among these studies that review scores were less than eight(OR 0.62, 95%CI 0.48 to 0.80, P=0.000 2). Conclusion It is not certain that neoadjuvant chemotherapy improved in survival in patients with non-small cell lung cancer. It needs further trials to be evidenced.