射频消融联合化疗治疗晚期非小细胞肺癌疗效的Meta分析

Radiofrequency ablation and chemotherapy combination versus chemotherapy monotherapy in non-small cell lung cancer:A systematic review of meta analysis

目的评价射频消融(RAF)联合化疗与单纯化疗治疗晚期非小细胞肺癌(NSCLC)的疗效及安全性。方法采用计算机检索Cochrane图书馆、PubMed、Embase、SIGLE、ASCO、ESMO、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、数字化期刊全文数据库(时间均为1999年至2011年6月)。纳入射频消融联合化疗与单纯化疗治疗晚期NSCLC的临床对照试验。由两名评价者独立按Cochrane系统评价手册5.1版推荐的标准评价纳入研究的质量,并采用Cochrane协作网提供的RevMan 5.1软件进行Meta分析,合并值为相对危险度(RR)。结果纳入13个研究共863例患者。Meta分析结果显示:与单纯化疗相比,RAF联合化疗能够提高近期疗效(RR=0.93,95%CI:0.72～1.20)和降低毒副反应(RR=1.34,95%CI:0.73～2.46),但差异无统计学意义;RAF联合化疗可以降低术后复发率(RR=0.51,95%CI:0.32～0.82)和提高生存率(RR=1.49,95%CI:1.35～1.65),差异均有统计学意义(P=0.006),但并发症较高(RR=14.76,95%CI:8.86～24.60);而生存质量改善无差别(KPS评分法:RR=1.01,95%CI:0.64～1.60)/(中国1990标准:RR=0.89,95%CI:0.27～2.96)。结论目前证据表明,RAF联合化疗能够提高晚期NSCLC患者的生存率并降低术后复发率,为其治疗提供了一种新的治疗手段。但在近期疗效、生存质量及毒副作用方面无显著改善,同时并发症的发生率较高。因此建议对应用RAF联合化疗治疗晚期NSCLC患者的疗效和安全性持审慎态度,尚需进一步开展大规模、高质量的临床研究进行证实。

Objective To estimate the efficacy and safety of radiofrequency ablation （RFA） combined with chemotherapy in comparison with chemotherapy alone in the treatment of advanced non-small cell lung cancer（NSCLC）. Methods We searched the Cochrane Library,PubMed,Embase, ASCO, ESMO, SIGLE, CBM,CNKI, VIP and Wanfang （from 1999 to June 2011） for relevant studies. Two reviewers independently retrieved clinical controlled trials according to the inclusion and exclusion criteria, assessed the methodological quality of included trials, and extracted data. Meta-analysis was performed by RevMan 5.1 software. Results Thirteen studies involving 863 patients were ultimately included. The resuhs of recta-analyses showed RFA in combination with chemotherapy can improve short-term effect （ RR = 0. 93,95% CI：0. 72-1.20） and lower drug toxicity （RR = 1.34,95% CI：0. 73-2. 46）, but the differences between two groups have no statistical significance. Combination can reduce postoperative recrudescence （RR = 0. 51,95% C1：0. 32-0. 82） and increase survival rate （ RR = 1.49,95% CI ： 1.35-1.65 ）, the differences between two groups have statistical signif- icance,but the complications were higher （RR = 14.76,95% C1：8.86-24.60）. Improvement of survival quality had no difference ei- ther by KPS scoring method （ RR = 1.01,95 % C1：0. 64-1. 60） or Chinese scoring method in 1990 （ RR = 0. 89,95 % CI： 0.27-2. 96 ）. Conclusion The results of meta-analyses indicate that RFA in combination with chemotherapy can improve survival rate and lower postoperative recrudescence, provides a new adjunct for clinical treatment of advanced NSCLC. But there is no remarkable significant in improvements of recent efficacy and life quality as well as reduction of drug toxicity, at the same time, complication rates were higher. So we suggest we should maintain the prudent attitudes, and the efficacy and safety of RFA in combination with chemotherapy in patients with advanced NSCLC need reliable evidence provided by large-scale and high-quality clinical research.