紫杉醇联合顺铂/依托泊苷与顺铂/依托泊苷治疗小细胞肺癌的系统评价

The effect of Paclitaxe combined with Cisplatin and Etoposide comparing with Cisplatin and Etoposide on patients with small cell lung cancer: a systematic review

目的系统评价紫杉醇、顺铂和依托泊苷三药联合治疗小细胞肺癌的近期效果及安全性。方法计算机检索PubMed、Cochrane library、EMBASE、中国学术期刊全文数据库(CNKI)、万方数据(WanFang)等数据库中研究对象为小细胞肺癌的相关临床随机对照试验,治疗组为紫杉醇、顺铂、依托泊苷三药联合,对照组为顺铂联合依托泊苷,比较两组治疗后的近期效果与不良反应情况,时间截至2013年6月。使用Revman 5.1.0软件进行数据统计与分析。结果最终纳入5项研究,共933例患者。Meta分析结果表明:广泛期SCLC患者中,PET组与PE组的客观有效率比较差异有统计学意义(P=0.003);白细胞减少及血小板严重减少的差异有统计学意义(P<0.05)。漏斗图显示无明显发表偏倚。结论 PET方案可提高广泛期小细胞肺癌患者的近期疗效,但更易发生血液学毒性,仍需高质量的多中心、大样本、随机对照临床证据来进一步证实此结果。

Objective To evaluate the effect and safety of Paclitaxel, Cisplatin combined with Etoposide on the recent efficacy and safety of patients with small cell lung cancer （SCLC）. Methods Electronic databases including PubMed, the Cochrane library, EMBASE, CNKI and database system of WanFang were searched, until June 2013. The random- ized controlled clinical studies of the chemotherapy of small cell lung cancer were chosen according to criteria, in which the treatment group was given paelitaxel combined with Cisplatin and Etoposide （PET）, the control group was given Cisplatin and Etoposide, the recent effect and side effats after treatment of the two groups were compared. Revman 5.1.0 software was used for data analysis. Results Five studies including 933 cases of SCLC were included. based on the inclusion criteria. The results of the Meta-analysis exhibited that there were significant differences in re- cent efficacy between PET regimen and PE regimen （P = 0.003）, whereas the differences were also significant in hema- tologic toxieities （P 〈 0.05）. Funnel plot indicated no publication bias. Conclusion PET regimen is effective to improve the recent efficacy of extensive stage small cell lung cancer patients as compared with PE regimen, however, a higher hematologic toxicity is also observed in PET group. More higher quality RCTs are needed to further validate the results.