非小细胞肺癌患者ERCC1表达与铂类药物化疗敏感性的相关性的系统分析

Relationship between ERCC1expression and sensitivity of platinumbased chemotherapy in NSCLC:a systematic review

目的:分析非小细胞肺癌患者切除修复交叉互补基因1(ERCC1)表达与对铂类药物治疗敏感性的相关性。方法:电子检索Medline(1991.1-2009.12)、Pubmed、CBMDisc等数据库,对回顾性病例研究和随机对照临床试验进行总结分析。结果:共纳入10篇文献,包括9篇回顾性病例研究和1篇随机对照临床试验。9篇回顾性病例研究资料中,7篇结果表明ERCC1表达阴性患者对铂类药物的联合化疗方案的反应率高于阳性患者(2篇结果具有统计学意义),另2篇ERCC1表达阴性患者对铂类药物的联合化疗方案的反应率低于阳性患者;1篇文献报道化疗后肿瘤进展时间ERCC1阴性组患者显著长于ERCC1阳性组患者(P<0.05);化疗后中位生存期具有统计学差异的2篇报道均为ERCC1阴性组高于ER-CC1阳性组(P<0.05)。RCT研究结果表明辅助化疗可以明显延长ERCC1阴性患者的生存期,但不能延长ERCC1阳性患者的生存期。结论:非小细胞肺癌患者中ERCC1低表达者可以从铂类化疗方案中受益,高表达者对铂类药物的化疗敏感性差,需要更好的辅助治疗方案。ER-CC1作为预测NSCLC对铂类药物化疗方案敏感性的指标并指导临床个体化治疗具有临床意义。

AIM： To evaluate the relationship between the expression of excision repair crosscomplement 1 （ERCC1） gene and platinumbased chemotherapy sensitivity in non-small cell lung cancer. METHODS： Database including Medline （1991.1--2009.12）, Pubmed, CBMDisc were searched and randomized clinical trials as well as retrospective case studies were collected. Meta analysis was executed using RevMan 4.2 software. RESULTS： One randomized controlled trial （RCT） and nine case reports were identified and anlyzed. The results of nine case reports indicated that the response rate of ERCCl-negative patients to platinum-based chemotherapy was obviously higher than that of ERCCl-positive patients（P=0.02）. One retrospective research reported longer time to progression （TTP） （P〈 0.05） and two reported longer overall survival in ERCCl-negative patients （P 〈 0.05） compared with those ERCCl-positive patients. The results of RCT indicated that adjuvant chemotherapy significantly prolonged survival among low ERCC1 expression patients compared with observation but not among patients with high ERCC1 expression. Better adjuvant regimen for high ERCC1 patients is needed. CONCLUSION： Low ERCC1 expression patients are benefit from platinum-based chemotherapy, but patients with high ERCC1 expression are not sensitive to platinum-based chemotherapy. ERCC1 is a useful biomarker to clinically predict the efficacy of adjuvant chemotherapy in NSCLC.