培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的Meta分析

Pemetrexed versus Docetaxel for Advanced Non-Small-Cell Lung Cancer:A Meta-analysis

目的系统评价培美曲塞与多西紫杉醇治疗晚期非小细胞肺癌(NSCLC)的疗效与安全性。方法计算机检索Cochrane Library、PubMed、EMbase、SCI、CBM、CNKI和VIP,同时辅助其他检索方式,纳入培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的临床随机对照试验,检索时间截至2010年11月。由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan5.0软件进行Meta分析。结果共纳入5个研究,合计847例患者。Meta分析结果显示:在疗效方面,培美曲塞与多西紫杉醇相比,两者在有效率[OR=1.09,95%CI(0.7,1.70)]、疾病控制率[OR=0.99,95%CI(0.75,1.31)]、1年生存率[OR=1.11,95%CI(0.56,2.18)]等方面差异无统计学意义;在安全性方面,与多西紫杉醇相比,培美曲塞可降低中性粒细胞减少[OR=0.09,95%CI(0.05,0.15)]和粒细胞性发热[OR=0.13,95%CI(0.06,0.29)]、减少脱发[OR=0.20,95%CI(0.12,0.33)],而在血红蛋白[OR=1.45,95%CI(0.23,9.06)]、血小板减少[OR=1.46,95%CI(0.59,3.59)]、恶心呕吐[OR=1.23,95%CI(0.53,2.83)]、疲劳乏力[OR=0.73,95%CI(0.40,1.30)]等方面两者差异无统计学意义。结论当前证据显示,培美曲塞与多西紫杉醇治疗晚期NSCLC的疗效相当,但可减少中性粒细胞减少、粒细胞性发热和脱发等不良反应。

Objective For the dispute on the superiority of the pemetrexed compared with the docetaxel for treating advanced non-small-cell lung cancer（NSCLC）,this study is conducted to evaluate the efficacy and safety of pemetrexed versus docetaxel for patients with NSCLC.Methods Such databases as The Cochrane Library,PubMed,EMBASE,SCI,CBM,CNKI,and VIP were searched to collect the randomized controlled trials（RCTs） about pemetrexed versus docetaxel for the treatment of NSCLC published before November of 2010.Two reviewers independently screened the studies,extracted the data and assessed the methodology quality.RevMan 5.0 software was used for meta-analyses.Results Five studies involving 847 patients were included.The results of meta-analyses showed that,in the aspect of efficacy,there was no significant difference between the two groups in the effective rate（OR=1.09,95%CI 0.7 to 1.70）,the disease control rate（OR=0.99,95%CI 0.75 to 1.31）,and the one-year survival rate（OR=1.11,95%CI 0.56 to 2.18）;in the aspect of safety,compared with docetaxel,pemetrexed could reduce the neutropenia（OR=0.09,95%CI 0.05 to 0.15）,the febrile neutropenia（OR=0.13,95%CI 0.06 to 0.29） and the alopecia（OR=0.20,95%CI 0.12 to 0.33）,but no significant difference was found in haemoglobin（OR=1.45,95%CI 0.23 to 9.06）,thrombocytopenia（OR=1.46,95%CI 0.59 to 3.59）,nausea and vomiting（OR=1.23,95%CI 0.53 to 2.83） and fatigue and debilitation（OR=0.73,95%CI 0.40 to 1.30）.Conclusion？As the current evidence shows,pemetrexed has similar efficacy to docetaxel for advanced NSCLC patients,but it has fewer side effects of neutropenia,febrile neutropenia and alopecia.