术前辅助化疗在可切除非小细胞肺癌中的地位:一项13个随机对照临床试验的荟萃分析

Preoperative induction chemotherapy for resectable stage ⅢA non-small-cell lung cancer:a meta-analysis of 13 double-blind, randomized clinical trials

背景与目的术前化疗对于可切除的非小细胞肺癌的作用目前仍不明确,通过荟萃分析对评估术前化疗对于非小细胞肺癌生存率改善的有效性。方法在MEDLINE、PUBMED、OVID、Cochrane图书馆、Cancerlit、ClinicalTrials.gov和ASCO网站、ESMO网站及CBMdisc数据库对相关文献进行了检索并选出符合要求的文献进行meta分析,主要比较了术前化疗后再手术和单独手术对非小细胞肺癌的患者生存率的影响。用死亡风险优势比OR值来评估生存率改善的有效性。结果13个合格的临床随机对照试验入选,共包括了2561个患者。结果表明术前化疗可改善患者的生存率,合并OR值为0.80,95%可信区间0.68-0.94,P=0.008,差异具有统计学意义。亚组分析中显示IIIa期的非小细胞肺癌患者也受益于术前化疗。文献没有统计学异质性。结论此次分析表明术前化疗对于改善非小细胞肺癌患者的生存率有明显益处,Meta分析也是目前评估这种治疗有效性的最好方法。

Background and Objective The role of Preoperative chemotherapy in patients with resected nonsmall-cell lung cancer （NSCLC） remains unclear, this study is aimed at evaluating the effectiveness of Preoperative chemotherapy in patients with resected non-small-cell lung cancer （NSCLC）, by performing a meta-analysis of relevant trials. Methods Searching the literature from MEDLINE, pubmed, OVID, The Cochrane library, Cancerlit, Clinicahrials. gov, ASCO, ESMO and CBM database, a meta-analysis was carried out to compare patients with NSCLC receiving chemotherapy before surgery with those undergoing surgery alone. The odds ratio （OR） was estimated to assess the survival advantage of Preoperative chemotherapy. Results Thirteen eligible randomized controlled trials （RCT） were identified, including 2561 patients, the meta-analysis showed preoperative chemotherapy improved survival with a OR of 0.80 （95% confidence interval, 0.68-0.94; P=0.008） in a subset analysis patients with Ⅲa stage also benefit from the preoperative chemotherapy. There was no evidence of statistical heterogeneity. Conclusion This analysis shows a significant benefit of preoperative chemotherapy and is currently the best estimate of the effectiveness of this therapy.