塞来昔布联合放化疗对比单纯放化疗治疗晚期非小细胞肺癌疗效与安全性的Meta分析

Efficacy and Safety of Celecoxib Combined with Chemoradiotherapy vs. Chemoradiotherapy Alone in the Treatment of Advanced Non-small Cell Lung Cancer:A Meta-analysis

目的:系统评价塞来昔布联合放化疗对比单纯放化疗治疗晚期非小细胞肺癌(NSCLC)的疗效与安全性,以为临床治疗提供循证参考。方法:计算机检索Pub Med、EMBase、Cochrane Library、中国期刊全文数据库、维普数据库、万方数据库,纳入塞来昔布联合放化疗(试验组)对比单纯放化疗(对照组)治疗晚期NSCLC的随机对照试验(RCT),由两位研究者按照纳入与排除标准独立筛选文献、提取资料及评价质量,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入8项RCT,合计1 319例患者。Meta分析结果显示,试验组能提高患者有效率[OR=1.35,95%CI(1.06,1.73),P=0.02],却也显著增加了不良反应发生率[OR=2.52,95%CI(1.81,3.50),P<0.000],与对照组比较差异均有统计学意义;两组患者中位生存时间[MD=-0.53,95%CI(-1.58,0.51),P=0.32]和1年生存率[OR=1.21,95%CI(0.95,1.53),P=0.12]比较差异均无统计学意义。结论:塞来昔布联合放化疗较单纯放化疗可显著提高NSCLC患者的有效率,但亦增加了不良反应发生率,而对中位生存时间和1年生存率无显著影响,临床上综合治疗应视个体具体情况而定。由于纳入研究数量较少、质量偏低,该结论有待大样本、高质量的RCT进一步证实。

OBJECTIVE：To evaluate therapeutic efficacy and safety of celecoxib combined with chemoradiotherapy vs. chemoradiotherapy alone in the treatment of advanced non-small cell lung cancer（NSCLC）,and to provide evidence-based reference for clinical treatment. METHODS：Retrieved from Pub Med,EMBase,Cochrane Library,CNKI,VIP and Wanfang databases by computer,RCTs about celecoxib combined with chemoradiotherapy in the treatment of advanced NSCLC were included. According to the inclusive and exclusive criteria,literatures and data were independently screened and extracted by two researchers,and the qualities of the studies were evaluated. Meta-analysis was conducted by Rev Man 5.2 statistical software. RESULTS：A total of 8 RCT were included,involving 1 319 patients. Meta-analysis showed that experiment group could significantly improve response rate[OR=1.35,95%CI（1.06,1.73）,P=0.02],but increased the incidence of ADR [OR=2.52,95%CI（1.81,3.50）,P〈0.000];there was statistical difference between control group and experiment group. There were no significant differences in median survival time[MD=-0.35,95% CI（-1.58,0.51）,P=0.32] and 1-year survival rate [OR=1.21,95% CI（0.95,1.53）,P=0.12] between 2groups. CONCLUSIONS：Celecoxib combined with chemoradiotherapy can improve overall response rate but increase the incidence of ADR in NSCLC patients,while have no obvious effect on median survival time and 1year survival rate. Clinical treatment depends on individual conditions. Due to small scale and low quality of included studies,more large-scale and high quality RCTs are required for further validation.