^(125)I粒子组织间植入治疗肺癌有效性和安全性的Meta分析

Efficacy and Safety of ^(125)I Seed Interstitial Implantation for Lung Cancer:A Meta-analysis

目的系统评价125I粒子组织间植入治疗肺癌的有效性和安全性。方法计算机检索PubMed、The Wiley Online Library、Elsevier、CNKI、VIP和WanFang Data数据库,搜集125I粒子组织间植入治疗肺癌的相关随机对照试验(RCT),检索时限均为从建库至2014年2月。由两位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.1软件进行Meta分析。结果共纳入23个RCT,包括1 492例患者。Meta分析结果显示:125I粒子植入组的治疗有效率[OR=3.43,95%CI(2.71,4.33),P<0.000 01]、1年生存率[OR=2.83,95%CI(2.03,3.95),P<0.000 01]和2年生存率[OR=2.49,95%CI(1.60,3.88),P<0.000 01]明显高于对照组,但术后并发症发生率明显高于对照组[OR=19.72,95%CI(11.63,33.45),P<0.000 01]。两组3年生存率[OR=2.45,95%CI(0.21,28.89),P=0.48]和不良反应发生率差异无统计学意义[OR=0.74,95%CI(0.52,1.05),P=0.09]。结论 125I粒子组织间植入是治疗肺癌的有效方案,能有效提高患者近期治疗有效率和短期生存率,但会明显增加气胸、粒子移位和出血等并发症的发生率。受纳入研究质量限制,本研究结论尚需进一步开展高质量、大样本、多中心的RCT进行验证。

Objective To systematically evaluate the efficacy and safety of ^125I seed interstitial implantation for lung cancer. Methods We searched PubMed, The Wiley Online Library, Elsevier, CNKI, VIP and WanFang Data from inception to February 2014 to collect randomized controlled trials（RCTs） of ^125I seed interstitial implantation in the treatment of lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by using RevMan 5.1 software. Results A total of 23 RCTs involving 1 492 patients were included. The results of meta-analysis showed that： the effective rate（OR=3.43,95%CI2.71,4.33,P0.000 01）, 1 year survival rate（OR=2.83, 95%CI 2.03 to 3.95, P〈0.000 01） and 2 year survival rate（OR=2.49,95%CI 1.60 to 3.88, P〈0.000 01） in the ^125I seed interstitial implantation group were higher than those in the control group,but the rate of postoperative complications was higher than that of control group（OR=19.72, 95%CI 11.63 to 33.45,P〈0.000 01）. In addition, there were no significant differences between both groups in the 3 year survival rate（OR=2.45,95%CI 0.21 to 28.89, P=0.48） and the adverse reaction rate（OR=0.74, 95%CI 0.52 to 1.05, P=0.09）. Conclusion ^125I seed interstitial implantation is effective in the treatment of lung cancer. It can improve treatment efficiency and shorttime survival rate, but may increase the rate of complications such as pneumothorax, seed malposition, bleeding and so on. Due to the limited quality and quantity of included studies, more high quality and larger sample studies are needed to verify the above conclusion.