培美曲塞联合铂类对比吉西他滨联合铂类治疗晚期非小细胞肺癌的meta分析

A meta-analysis of Pemetrexed plus Platinum Chemotherapy versus Gemcitabine plus Platinum Chemotherapy for Advanced Non-small Cell Lung Cancer

背景与目的培美曲塞联合铂类方案(PP方案)作为晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)一线化疗方案的疗效是否优于吉西他滨联合铂类方案(GP方案),目前尚无定论。本研究旨在评价采用PP方案与GP方案治疗晚期NSCLC的疗效及安全性。方法计算机检索Pubmed、EMBASE、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库等,同时追查纳入文献的参考文献,纳入PP方案对比GP方案治疗晚期NSCLC的随机对照试验(randomized controlled trial,RCT)。根据Cochrane Handbook5.0的质量评价标准,用RevMan5.0软件进行统计学分析。结果共纳入4项RCT,2,235例患者,meta分析结果显示采用PP方案与GP方案治疗后在1年生存率(OR=1.09,95%CI:0.91-1.29)、有效率(OR=1.00,95%CI:0.40-2.52)等方面的差异无统计学意义,而在总生存时间(MD=0.26,95%CI:0.21-0.30)、脱发(OR=0.51,95%CI:0.39-0.66)及血液毒性等方面的差异有统计学意义。结论 PP方案与GP方案在1年生存率、有效率方面疗效相当,在总生存时间、不良反应等方面有差异,PP方案可能对不耐受血液毒性、脱发等患者更适合。

Background and objective Whether pemetrexed plus platinum（PP） regimen is superior to gemcitabine plus platinum（GP） regimen for patients with advanced non-small cell lung cancer（NSCLC） is unclear.The aim of this study is to evaluate the efficacy and safety of PP versus GP regimens for patients with NSCLC.Methods We searched relevant randomized controlled trials（RCTs） from Pubmed,EMBASE,Cochrane Library,Chinese Journal Full-text Database,Chinese Biomedical Literature Database,Chinese Scientific Journals Full-text Database,and traced the related references to obtain the information that has not been found.We made quality assessment of qualified RCTs assessed by the exclusion and inclusion criteria and used RevMan 5.0 provided by the Cochrane Collaboration to perform meta-analysis.Results Four RCTs involving 2,235 patients were identified.There were no statistical differences between PP and GP regimens in one-year survival rate（OR=1.09,95%CI：0.91-1.29）,the efficiency of disease（OR=1.00,95%CI：0.40-2.52）,but overall survival（MD=0.26,95%CI：0.21-0.30）,alopecia（OR=0.51,95%CI：0.39-0.66） and hematologic toxicity were significantly different.Conclusion The clinical efficiency of PP and GP regimens for advanced NSCLC was similar,but the side effects were different.The toxicity of PP regimen has the tendency to be more tolerable.