培美曲塞联合铂类一线治疗晚期NSCLC疗效与安全性Meta分析

Pemetrexed plus platinum as first-line treatment for advanced non-small cell lung cancer:a Meta-analysis

目的:采用Meta分析的方法,评价培美曲塞联合铂类(PPC方案)一线治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效和安全性。方法:计算机检索PubMed、EMBASE、Cochrane数据库、中国期刊全文数据库和中国生物医学文献数据库等,纳入PPC方案治疗初治的晚期NSCLC随机对照试验(randomizd controlled trail,RCT),2位研究者独立评估试验质量和提取数据;使用RevMan 5.2软件进行Meta分析。结果:共纳入6项RCT,包括3 057例晚期NSCLC患者。Meta分析结果显示,PPC方案治疗晚期NSCLC患者与其他含铂方案(PBR方案)比较,有效率(OR=1.18,95%CI:0.77~1.81,P=0.45)和1年生存率(OR=1.11,95%CI:0.82~1.49,P=0.51)差异无统计学意义;无疾病生存时间(progression free survival,PFS)差异无统计学意义(HR=1.01,95%CI:0.93~1.11,P=0.75);但在总的生存时间(overall survival,OS)方面,PPC方案略有优势(HR=0.92,95%CI:0.84~1.01,P=0.07),尤其是非鳞癌患者更能从中获益(HR=0.87,95%CI:0.77~0.99,P=0.03)。与PBR方案相比,PPC方案治疗晚期NSCLC患者3~4级白细胞减少、中性粒细胞减少以及粒缺性发热方面发生率较低,但3~4级消化道反应更为常见。结论:PPC方案一线治疗晚期NCSLC患者具有较好的疗效和安全性,尤其适合非鳞癌的患者。

OBJECTIVE： To evaluate the efficacy and safety of Pemetrexed plus Platinum （PPC） as the first-line treatment for advanced non-small cell lung cancer （NSCLC）. METHODS： A meta analysis was performed using trials i- dentified through PubMed, EMBASE,Cochrane databases, Chinese Journal Full-text Database and Chinese Biomedical Lit- erature Database. PPC treatment of previously untreated advanced NSCLC randomized controlled trials （RCT） were in- cluded. Two investigators independently assessed the quality of the trials and extracted data,and RevMan 5.0 was used to perform meta analysis which provided by the Cochrane Collaboration. RESULTS： Six RCT and 3 057 patients with ad- vanced NSCLC were included in this study;Meta-analysis showed that,PPC treatment of advanced NSCLC patients,com- pared with other platinum-containing solution （PBR plan）, the difference of efficient （OR = 1.18,95 ~ CI：0. 77- 1.81, P=0.45） and 1-year survival （OR=I. 11,95~CI：0.82--1.49,P--0.51） was not statistically significant;PPC compared with PBR,the disease-free＇survival PFS） was no significant difference （HR=I. 01,95~CI：0.93 1. 11,P=0.75）;In o verall survival time （OS）, PPC owned little advantage （ HR= 0.92,95 % CI ： 0.84-- 1.01, P = 0.07）, especially in patients with non-squamous cell carcinoma （ HR = 0. 87,95 % CI： 0. 77 -- 0.99, P = 0.03 ） ; Compared with PBR, PPC led to less grade 3 to 4 neutropenia/leukopenia,but 3 to 4 gastrointestinal reactions were more common level. CONCLUSION： PPC program first-line treatment of patients with advanced NCSLC has better efficacy and safety, especially for patients with non--squamous cell carcinoma.