TP、TC与NP方案治疗晚期非小细胞肺癌的系统评价

A systematic review in paclitaxel plus platinum versus vinorelbine plus cisplatin for advanced non small cell lungcancer

目的比较紫杉醇联用顺铂(TP)或卡铂(TC)方案与长春瑞滨联用顺铂(NP)方案治疗晚期非小细胞肺癌的临床疗效和安全性。方法计算机检索Cochrane图书馆、Pubmed、中国生物医学文献数据库、中国知识资源总库和万方等数据库,检索时间截至2010年4月;纳入随机及半随机对照试验,采用Cochrane系统评价方法进行评价。结果共纳入19个研究2 593例患者,TP、TC与NP方案显示中位生存期、有效率和1年生存率的差异均不显著(P>0.05);3～4级血液学及胃肠道不良反应中,TP和TC方案白细胞减少、中性粒细胞减少、贫血、恶心呕吐发生率低于NP方案,血小板减少发生率高于NP方案。结论在临床疗效相近的情况下,对TP、TC或NP方案的选择需要参考药物的不良反应和患者的耐受性。

Objective To compare and evaluate the clinical efficacy and safety of paclitaxel plus platinum （TP and TC） versus vinorelbine plus cisplatin （NP） for patients with advanced nonsmall cell lung cancer. Methods Up to April 2010,the computer search was done on Cochrane Library, Pubmed, CBM, CNKI and Wanfang database, etc. to collect randomized controlled trials which involved comparison of paclitaxel plus platinum versus vinorelbine plus cisplatin for patients with advanced non-small cell lung canc er. Two reviewers evaluated the quality of included trials independently. The Cochrane Collaboratioffs software was used for metaanalyses. Results Nineteen studies involving 2593 patients were included. Meta-analysis demonstrated that the patients used TP and TC regimens had an equal medieval survival time,overall response rate and one-year survival rate in comparison with NP regimens. The toxicity analyses indicated that NP regimen led to more frequent grade 3 or 4 of leucopenia,neutropenia,anemia and nausea/vomiting,while TP and TC chemotherapy inclined to developing more grade 3 or 4 thrombocytopenia. Conclusion When the ef ficacy were similar between the vinorelbine plus cisplatin and paclitaxel plus platinum regimens,the choice of paclitaxel plus platinum or vinorelbine plus cisplatin depends on the toxicity of the drugs and patients＇ tolerance.