手术治疗局限期小细胞肺癌疗效的Meta分析

Meta-Analysis on Surgery in Limited-stage Small Cell Lung Cancer

【目的】评价手术切除对局限期小细胞肺癌的治疗意义,为临床治疗方案选择提供循证依据。【方法】检索Pubmed、CNKI中文数据库、中国生物医学文献数据库（CBM）、万方中文数据库等数据库,有关包含手术与非手术治疗局限期小细胞肺癌疗效比较的临床对照研究相关文献,按纳入排除标准由2名研究者独立进行筛选并提取相关资料,采用Revman5.2统计软件进行Meta分析。【结果】16篇文献纳入分析,其中英文文献为2篇,余均为中文文献。有关3年生存率的12个研究,异质性分析P=0.22,I2=23%,合并OR=2.38,95%CI 1.86~3.04,P〈0.001;提供5年生存率的12个研究,各研究之间有异质性,根据治疗方式进一步行亚组分析：组1为＂夹心式＂综合治疗模式（先放化疗再手术序贯放化疗）与单纯放化疗比较;组2为手术序贯放化疗与单纯放化疗比较。分组后组内各研究无异质性,采用固定效应模式进行Meta分析,组1合并OR=7.44,95%CI 4.12~13.43,P〈0.001,组2合并OR=3.34,95%CI 2.26~4.93,P〈0.001。【结论】含手术切除的综合模式治疗的患者,3年或5年生存率都比非手术切除模式治疗的患者比例高。

【Objective】 To evaluate the treatment significance of surgery in limited-stage SCLC, and provide the evidence-based basis for the clinical treatment options. 【Methods】 Controlled clinical trials were included surgical and non-surgical treatment within the limited-stage SCLC were identified with Pubmed, CNKI, CBM, Wanfang. Meta-analysis was perfected using Revman 5.2 statistics software. 【Results】 16 trials achieving all the criteria, involving 2 trials in English and the rest in Chinese. About 3-year survival rate of 12 studies, the result of tests for heterogeneity was P = 0.22,I2= 23%（OR = 2.38,95%CI 1.86 ~ 3.04,P 0.001）. About 5-year survival rate of 12 studies, because of the heterogeneity, so according to the treatment into subgroup analysis ： group 1 was＂Sandwich＂ model of comprehensive treatment（first chemoradiation again surgery sequential chemoradiation） compared with pure chemoradiation; group 2 was Surgery sequential chemoradiation compared with pure chemoradiation. No heterogeneity within the groups, it was the fixed effects model for Meta-analysis. Group 1 was OR=7.44,95%CI 4.12 ~ 13.43,P 〈0.001,and group 2 was OR= 3.34,95% CI 2.26 ~ 4.93,P〈0.001. 【Conclusion】 The 3-year and 5-year of survival rates of patients using surgical removal comprehensive treatment model were higher than those of patients using non-surgical removal treatment mode.