NP化疗联合热疗治疗非小细胞肺癌的Meta分析

Thermotherapy plus NP for patients with non-small cell lung cancer:a Meta analysis

目的:评价长春瑞滨加顺铂(Navelbine plus Cisplatin,NP)化疗联合热疗治疗非小细胞肺癌的疗效及安全性,为临床实践与研究提供参考。方法:计算机检索Cochrane Library、PubMed、EMBASE和中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库、数字化期刊全文数据库,同时辅以其他检索。收集所有比较NP化疗联合热疗与单纯NP化疗的随机对照试验(randomized controlled trials,RCTs)。根据Cochrane系统评价手册5.0质量评价标准对纳入文献进行质量评价,并使用RevMan5.0软件进行Meta分析。结果:共纳入12篇RCT(717例患者)。Meta分析结果显示:NP化疗联合热疗与单纯NP化疗相比,其总有效率、症状改善率、生活质量改善率和1年生存率的差异均有统计学意义,其OR值和95%CI分别为[2.28,(1.67,3.12)]、[2.44(1.29,4.63)]、[3.38(2.27,5.03)]、[2.14(1.12,4.07)];骨髓抑制、消化道反应、神经毒性、静脉炎、心肺反应、皮肤反应和发热等安全性指标上,只有发热反应发生率的差异有统计学意义,其OR值和95%CI为[4.50,(1.74,11.64)]。结论:相较于单纯化疗,NP方案化疗联合局部热疗能提高患者远期生存率和近期疗效,改善症状,提高患者的生活质量,并且其安全性可以接受,推荐结合患者具体情况进行临床应用。

Objective：To evaluate the clinical efficacy and safety of Navelbine and Cisplatin（NP） combined with thermotherapy for non-small cell lung cancer（NSCLC） ,and to provide the reference for clinical practice and research. Methods：We searched English databases as Cochrane Library,PubMed,EMBASE and Chinese ones as CBM,CNKI,VIP and Wanfang with computer and also retrieved other sources as supplying,such as tracing related references,besides we also communicated with other authors to obtain some certain information that has not been found. All relevant randomized controlled trials（RCTs） were collected to compare NP plus thermotherapy and NP chemotherapy alone.The quality of the included trials was assessed by Cochrane Handbook 5.0 for cystematic review. Meta-analyses were conducted by RevMan 5.0 software. Results：12 RCTs were involved with 717 patients included. Meta-analysis showed：comparing NP plus thermotherapy with pure NP chemotherapy,there were significant difference in the indicators of 1-year survival rate,total effective rate,improvement rate of symptoms and improvement rate of life quality;the OR value and 95%CI were respectively[2.28,（1.67,3.12） ],[2.44（1.29,4.63） ],[3.38（2.27,5.03） ],[2.14（1.12,4.07） ].The incidences of NP plus thermotherapy was higher than that of pure NP chemotherapy on the indicators of fever reaction,and there was statistically significant with OR and 95%CI [4.50,（1.74,11.64） ]. But there was no significant difference in the indicators of myelosuppression,alimentary canal reactions,neurotoxicity,phlebitis,cardiopulmonary reaction,cutaneous reaction and fever reaction. Conclusion：Compared with the pure NP chemotherapy,NP combined with thermotherapy can improve long-term survival rate and short-term curative effect,ameliorate symptoms and the quality of life.Its safety can be accepted,so we recommend this model of therapy in clinical practice. But its long-term survival rate and more comprehensive security still need to be further verified by more large sample and high quality RCTs.