洛铂对比顺铂治疗晚期非小细胞肺癌疗效和安全性的Meta分析

Efficacy and Safety of Lobaplatin-based versus Cisplatin-based Chemotherapy in the Treatment of Advanced Non-small Cell Lung Cancer:A Meta-analysis

目的:系统评价以洛铂为主的联合化疗方案对比以顺铂为主的联合化疗方案治疗晚期非小细胞肺癌(NSCLC)的疗效和安全性,以为临床提供循证参考。方法:计算机检索Cochrane Library、PubMed、EMBase、中国期刊全文数据库、中国生物医学文献数据库、维普中文期刊数据库、万方数据库,纳入以洛铂为主的联合化疗方案对比以顺铂为主的联合化疗方案治疗晚期NSCLC的随机对照试验(RCT),运用改良后的Jadad量表评价纳入文献的方法学质量,并采用Cochrane协作网提供的Rev Man 5.2统计学软件进行Meta分析。结果:共纳入11项RCT,合计724例患者。Meta分析结果显示,试验组患者的客观缓解率[RR=0.96,95%CI(0.79,1.16),P=0.65]、白细胞减少发生率[RR=0.95,95%CI(0.83,1.08),P=0.42]和血小板减少发生率[RR=0.96,95%CI(0.80,1.15),P=0.68]与对照组比较差异无统计学意义;试验组患者恶心呕吐发生率[RR=0.55,95%CI(0.46,0.64),P<0.05]、腹泻发生率[RR=0.43,95%CI(0.31,0.61),P<0.05]显著低于对照组,两组比较差异有统计学意义。结论:以洛铂为主的联合化疗方案治疗NSCLC患者的疗效与以顺铂为主的联合化疗方案相当,但安全性优于后者。由于纳入研究的样本量偏小、质量较低,该结论尚需大样本、多中心的RCT进一步验证。

OBJECTIVE：To evaluate therapeutic efficacy and safety of lobaplatin-based vs cisplatin-based chemotherapy for advanced non-small cell lung cancer（NSCLC）,and to provide evidence-based reference for clinical use. METHODS：Retrieved from Cochrane Library,PubMed,EMBase,CNKI,CBM,VIP and Wanfang database,RCT about lobaplatin-based chemotherapy versus cisplatin-based chemotherapy for advanced NSCLC were included. The quality of included literatures was evaluated by modified Jadad scale,and Rev Man 5.2 software was adopted for Meta-analysis. RESULTS：A total of 11 RCT were included,involving724 patients. Meta-analysis showed there was no statistical significance in objective response rate（ORR）[RR=0.96,95%CI（0.79,1.16）,P=0.65],the incidence of leucopenia [RR=0.95,95%CI（0.83,1.08）,P=0.42] and thrombocytopenia [RR=0.96,95%CI（0.80,1.15）,P=0.68] in trial groups,compared with control group. The incidence of nausea and vomiting [RR=0.55,95%CI（0.46,0.46）,P〈0.05] and diarrhea [RR=0.43,95%CI（0.31,0.61）,P〈0.05] in trial group was significantly lower than in control group,there was statistical significance. CONCLUSIONS：Although therapeutic efficacy of lobaplatin-based chemotherapy is similar to cisplatin-based chemotherapy for NSCLC,but the former is safer than the latter. Due to small-scale and low-quality included studies,more large-scale and multi-center RCTs are required for the conclusion validation.