拓扑替康标准方案与周疗方案治疗小细胞肺癌的荟萃分析

Meta-analysis of effect and safety of standard regimens and weekly regimens of topotecan treating NSCLC

目的 用荟萃（Meta）分析法比较拓扑替康两种治疗方案的临床疗效和安全性,为临床医生在选择化疗方案时提供参考依据.方法 收集自PubMed建库至2013年7月10日发表的有关比较拓扑替康两种治疗方案有效性和不良反应发生率的文献,根据Meta分析的要求对检索到的原始文献进行质量评估,对符合要求的所有文献研究结果进行Meta分析,评估两种化疗方案对小细胞肺癌治疗的有效性和安全性.结果 有3篇文献符合纳入标准,在评价两组方案对患者有效率中总样本量为288例,其中周疗方案组165例,有效17例；标准方案组123例,有效21例.在评价两组方案对患者不良反应发生率中纳入2篇文献,总样本量132例,其中周疗方案组89例,Ⅲ/Ⅳ级粒细胞减少26例,Ⅲ/Ⅳ级血红蛋白减少17例,Ⅲ/Ⅳ级血小板减少18例；标准方案组43例,Ⅲ/Ⅳ级粒细胞减少发生39例,Ⅲ/Ⅳ级血红蛋白减少24例,Ⅲ/Ⅳ级血小板减少32例.两组方案对患者有效率影响中OR=0.49,95％可信区间0.23 ～1.01,跨过无效线；两组方案对患者Ⅲ/Ⅳ级粒细胞减少发生率的影响中OR =0.04,95％可信区间0.01 ～0.14,位于无效线的左侧；两组方案对患者Ⅲ/Ⅳ级血红蛋白减少发生率的影响中OR=0.27,95％可信区间0.11 ～0.63,位于无效线的左侧；两组方案对患者Ⅲ/Ⅳ级血小板减少发生率的影响中OR =0.12,95％可信区间0.04～0.32,位于无效线的左侧.结论 两种化疗方案在有效率方面的差异无统计学意义；周疗方案组在Ⅲ/Ⅳ级粒细胞减少的发生率、Ⅲ/Ⅳ血红蛋白减少的发生率低和Ⅲ/Ⅳ血小板减少的发生率等方面均低于标准方案组,差异有统计学意义.

Objective To compare the effect and safety of the two regimens of topotecan by means of Meta-analysis, in order to give evidences for doctors when selecting regimens. Methods All the studies that have been searched in Pub Med from setup data base to 2013-07-10 were evaluated strictly and meta-analysis was used to study the effect and safety of two regimens contain standard regimens and weekly regimens . The odds radio（OR） was calculate for incidence of efficiency and safety of two regimens. Results Totally 3 studies including 288 cases were analyzed in efficiency. 17 cases were effective in 165 cases of weekly regimens; 21 cases were effective in 123 cases of standard regimens. Totally 2 studies including 132 cases were analyzed in safety. 89 cases were in weekly regimens. Of which 26 cases of Ⅲ/Ⅳ neutropenia and 17eases of Ⅲ/Ⅳ low-hemoglobin and 32 cases of Ⅲ/Ⅳ thrombopenia. 43 ca- ses were in standard regimens. Of which 39 cases of Ⅲ/Ⅳ neutropenia and 24 cases ofⅢ/Ⅳ low-hemoglobin and 32 cases of Ⅲ/Ⅳ thrombopenia. The pooled OR of efficiency was 0.49 with a 95% confidence interval（0.23-1.01 ） ;the pooled OR of Ⅲ/Ⅳ neutrope- nia was 0.04 with a 95% confidence interval（0.01-0.14） ; the pooled OR of Ⅲ/Ⅳ low-hemoglobin was 0.27 with a 95% confidence interval（O. 11-0.63） ; the pooled OR ofⅢ/Ⅳ thrombopenia was 0.12 with a 95% confidence interval（0.04-0.32）. Conclusion Weekly regimens group compared to standard regimens group in efficiency had no statistical significance; Weekly regimens group com- pared to standard regimens group for preventing Ⅲ/Ⅳ neutropenia,Ⅲ/Ⅳ low-hemoglobin and Ⅲ/Ⅳ thrombopenia had statistical sig- nificance. Weekly regimens group was better to standard regimens group for preventing Ⅲ/Ⅳneutropenia, Ⅲ/Ⅳ low-hemoglobin andⅢ/Ⅳ thrombopenia.