射频消融联合放化疗治疗中晚期非小细胞肺癌的系统评价

A systematic review of radiofrequency ablation combined with radiotherapy or chemotherapy in the treatment of advanced non-small cell lung cancer

目的：评价射频消融（radiofrequency ablation,RFA）治疗中晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）的有效性和安全性。本研究旨在评价射频消融联合化疗或放化疗治疗中晚期非小细胞肺癌的有效性和安全性,并为临床实践与深入研究提供参考。方法：计算机全面检索Cochrane Library、Pub Med、EMBASE、中国生物医学文献数据库、中国学术期刊全文数据库、维普中文科技期刊数据库和万方数字化期刊全文数据库中有关射频消融联合化疗或放化疗治疗中晚期非小细胞肺癌的随机对照研究（randomized controlled trials,RCTs）和对照研究,时间截至2014年11月。由两位研究者逐篇评价纳入研究的质量、提取数据并交叉核对,采用Rev Man 5.2软件进行数据处理。结果：共纳入16项研究,共980例病人。Meta分析结果显示：射频消融联合化疗的6个月及1、2、3年总体生存率均优于单纯化疗（OR=5.57,95%CI：2.90~10.70）、（OR=2.01,95%CI：1.41~2.86）、（OR=2.4 8,9 5%CI：1.5 1~4.0 7）、（OR=2.2 9,9 5%CI：1.24~4.22）,且差异均有统计学意义（P〈0.05）,两组间并发症及不良反应发生率的差异无统计学意义（P〉0.05）;与放化疗相比,射频消融联合放化疗能提高患者的1年总体生存率（OR=2.09,95%CI：1.11~3.94）,并且能提高患者的KPS评分（OR=3.25,95%CI：1.60~6.61）,且差异均有统计学意义（P〈0.05）。结论：与单纯化疗相比,射频消融联合化疗在提高中晚期非小细胞肺癌患者生存率上有明显优势,并且不增加并发症和不良反应;与放化疗相比,射频消融联合放化疗能提高患者的生存率和生存质量,且安全性较好。

Objective：To evaluate efficacy and safety of radiofrequency ablation（RFA）treatment on advanced non-small cell lung cancer（NSCLC）.Methods：Relevant randomized controlled trials（RCTs）and controlled trials （CTs）were obtained from the Cochrane Library,PubMed,EMbase,CBM,CNKI,VIP and WanFang databases.RCTs and CTs of RFA combined with either CTY or RCTY on advanced NSCLC were also included before Nov,2014.Two researchers evaluated the quality of the items included.The data included in the study were evalusted and analyzed u-sing the Cochrane Collaboration＇s RevMan 5.2 software.Results：A total number of 16 studies involving 980 patients were included.The results of Meta -analysis showed that compared to CTY group,RFA plus CTY group can improve advanced NSCLC patients＇6 months,1 ,2 and 3 -year survival rate （OR =5 .5 7 ,95 % CI ：2 .90 ~1 0 .70 ）, （OR =2.01,95%CI：1.41 ~2.86）,（OR =2.48,95%CI：1.51 ~4.07）,（OR =2.29,95%CI：1.24 ~4.22）,were higher obviously（P 〈0.05）,and no additions on complications and adverse reactions（P 〉0.05）.In addition,com-pared to RCTY treatment,the RFA plus RCTY could improve overall rate survival rate of advanced NSCLC patients in a 1 -year period （OR =2.09,95%CI：1.11 ~3.94）.Similarly,the RFA plus RCTY could improve the KPS（OR=3.25,95%CI：1.60 ~6.61 ）,were higher obviously and had the statistical significant（P 〈0.05）.Conclusion：Compared to CTY alone,the RFA plus CTY solution has significant advantages on the survival rate of advanced NSCLC patients had no increase on complications and adverse reactions.Compared to RCTY,RFA plus RCTY can im-prove the survival rate and living quality of the patients.