铂类联合吉西他滨或长春瑞滨治疗晚期非小细胞肺癌的Meta分析

A Meta-Analysis of Platinum Plus Gemcitabine or Vinorelbine for Advanced Non-small Cell Lung Cancer

背景与目的以铂类为基础联合第三代药物的双药化疗方案是治疗晚期非小细胞肺癌的标准一线治疗方案。本研究用Meta分析方法评价吉西他滨(gemcitabine,GEM)或长春瑞滨(vinorelbine,NVB)联合铂类一线治疗晚期非小细胞肺癌(non small celllung cancer,NSCLC)的疗效和毒副作用差异。方法在CENTRAL、PubMed、EMBASE和中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库中检索铂类联合GEM或NVB治疗晚期NSCLC的随机对照临床试验(randomized controlled clinical trials,RCT)。对符合标准的文献进行质量评价和Meta分析。结果9篇文献(包括2186例患者)符合入选标准,缓解率和一年生存率在GEM组与NVB组无统计学差异(RR合并=0.91,95%CI:0.81-1.03,P=0.15;RR合并=1.06,95%CI:0.96-1.18,P=0.27);GEM组3-4级血小板减少发生率明显升高,NVB组3-4级中性粒细胞减少、静脉炎、腹胀便秘、周围神经毒性发生率明显升高,各指标差异均有统计学意义。结论铂类联合吉西他滨或长春瑞滨治疗晚期NSCLC的疗效相似,但血液学毒性和非血液学毒性存在明显差异,成为个体化治疗时选择化疗方案的主要考虑因素之一。

Background and objective Platinum plus the third-：generation agent doublet chemotherapy is the standard regimens and first line chemotherapy for advanced non-small cell lung cancer （NSCLC）. The aim of this study is to determine the benefits and harms of platinum plus gemcitabine or vinorelbine for advanced NSCLC. Methods The databases PubMed, CENTRAL, EMBASE and Chinese Biomedical Literature database were retrieved by using the key words ＂non small cell lung cancer＂ or ＂Carcinoma, Non Small Cell Lung＂ so as to search the studies about the randomized controlled clinical trials （RCT） that had compared the gemeitabine plus platinum versus vinorelbine plus platinum for advanced NSCLC. A meta-analysis was conducted. Results Nine randomized controlled trials, with total 2 186 patients, were included. The overall response rate and one-year survival rate of the gemcitabine group were not significantly different from that of vinorelbine regimen （RR=0.91, 95%CI： 0.81-1.03, P=0.15; RR=1.06, 95%CI： 0.96-1.18, P=0.27, respectively）. The incidence rate of grade 3-4 netropenia, constipation, phlebitis and grade 1-4 neuropathy were higher in vinorelbine group, just like higher incidence rate of grade 3-4 thromboeytopenia in the gemcitabine group. Conclusion The curative effects of the gemcitabine or vinorelhine plus platinum regimens are similar. The choice of gemcitabine or vinorelbine depends on the toxicity of the drugs and patients＇ tolerance.