支气管动脉灌注化疗与全身静脉化疗对晚期非小细胞肺癌患者疗效及不良反应发生率的META分析

Efficacy and adverse reactions of bronchial artery infusion and intravenous chemotherapy for treating advanced non-small cell lung cancer: a systematic review and meta-analysis

目的探讨支气管动脉灌注化疗与静脉全身化疗在中晚期非小细胞肺癌（NSCLC）患者治疗中的有效性及安全性。方法计算机检索Pub Med、Cochranelibrary、中国生物医学文献数据库（CBM）、中国知识资源总库（CNKI）、万方数据在线知识服务平台,收集国内外2000年至2014年间公开发表的有关NSCLC支气管动脉灌注化疗与全身静脉化疗临床对照试验的中英文文献,按照入选标准严格筛选文献并对文献质量进行评估,对最终入选的文献使用Rev Man5.0软件进行Meta分析。结果纳入分析的文献共计11篇,Meta分析显示NSCLC支气管动脉灌注化疗组有效率明显高于全身静脉化疗组（RR,1.57;95%CI,1.37-1.82;P〈0.001;I2=0%）,但两组患者1年生存率无统计学差异（RR,1.10;95%CI,0.91-1.33;P=0.30;I2=24%）。NSCLC支气管动脉灌注化疗组血小板降低发生率显著低于全身静脉化疗组（RR,0.69;95%CI,0.53-0.90;P=0.006;I2=0%）,但两组患者白细胞降低发生率无统计学差异（RR,0.77;95%CI,0.56-1.04;P=0.09;I2=87%）,恶心、呕吐发生率亦无统计学差异（RR,0.64;95%CI,0.30-1.37;P=0.25;I2=98%）。结论支气管动脉灌注化疗对晚期NSCLC的有效率明显高于全身静脉化疗,且能降低某些化疗不良反应的发生,可作为部分晚期NSCLC患者首选治疗方式之一。

Objective Lung cancer was one the most commonly diagnosed cancer as well as the leading cause of cancer death in China. The aim of this study is to assess the efficacy and adverse reactions of of bronchial artery infusion and intravenous chemotherapy for treating advanced non-small cell lung cancer（ NSCLC）. Methods By searching Pub Med,Cochranelibrary,Sino Med,China National Knowledge Internet and Wanfang Database,we collected both domestic and overseas published literatures between 2000 and 2014 on clinical control trial of bronchial artery infusion versus intravenous chemotherapy for treating advanced NSCLC. These literatures were strictly selected and the quality of selected literatures were assessed based on methodological index for non-randomized studies. Then we used the Rev Man 5. 0 software for meta-analysis.Results Eleven eligible literatures were included. The effective rate in bronchial artery infusion group is significantly higher than intravenous chemotherapy group（ RR,1. 57; 95% CI,1. 37-1. 82;P〈0. 001; I2=0%）,but no difference was observed in one-year survival rate（ RR,1. 10; 95% CI,0. 91-1. 33; P = 0. 30;I2= 24%）. In the trials with data on adverse reactions,bronchial artery infusion was associated with a significantly lower incidence of thrombocytopenia（ RR,0. 69; 95% CI,0. 53-0. 90; P = 0. 06; I2= 0%）,but there are no statistical differences in the incidence of leucopenia（ RR,0. 77; 95% CI,0. 56-1. 04; P = 0. 09;I2= 87%） and nausea / vomiting（ RR,0. 64; 95% CI,0. 30-1. 37; P = 0. 25; I2= 98%）. Conclusion Bronchial artery infusion is more effective than intravenous chemotherapy for treating advanced NSCLC,and it can also reduce some adverse reactions of chemotherapy.