诱导化疗＋同期放化疗对局部晚期NSCLC临床价值的Meta分析

Clinical value of induction chemotherapy plus concurrent radiochemotherapy for locally advanced non-small cell lung cancer： a Meta analysis

目的应用Meta分析方法评估同期放化疗前加诱导化疗在治疗局部晚期NSCLC中的价值。方法检索中国生物医学文献数据库、中国学术期刊全文数据库、Cochrane Library、Pubmed、EMbase国内外数据库有关局部晚期NSCLC患者诱导化疗＋同期放化疗与同期放化疗对比的文献，依据入选和排除标准收集各项研究的近期疗效及生存情况，应用Meta分析方法评价同期放化疗前加诱导化疗的临床疗效。结果纳入符合标准的国内外文献5篇，共包括845例患者。结果显示诱导化疗＋同期放化疗较同期放化疗在近期疗效及2、3年生存率方面均相近（OR=0．875，95％CI为0．507—1．510，P=0．631；HR=0．770，95％CI为0．515—1．151，P=0．203；HR=0．809，95％CI为0．559—1．172，P=0．262），但≥3级白细胞下降发生率明显增加（OR=0．637，95％CI为0．435—0．931，P=0．020）。结论同期放化疗前加诱导化疗在近期疗效和2、3年生存率并未显示优势，而骨髓抑制明显增加。限于纳入研究较少，病例数偏少，尚需开展多中心随机研究提供更为详实的数据来进一步明确诱导化疗＋同期放化疗的临床价值。

Objective To investigate the clinical effect of induction chemotherapy plus concurrent radiochemotherapy in the treatment of locally advanced non-small cell lung cancer （NSCLC） through a metaanalysis. Methods CBM, CNKI, Cochrane Library, PubMed, and EMbase were searched for the articles on comparison between induction chemotherapy plus concurrent radiochemotherapy and concurrent radiochemotherapy for patients with locally advanced NSCLC. According to the inclusion and exclusion criteria, the data on short-term outcome and survival were collected. A Meta-analysis was performed to evaluate the clinical effect of induction chemotherapy followed by concurrent radiochemotherapy. Results A total of 5 articles were included, which involved 845 patients. The results showed that the short-term outcome and the 2-and 3-year survival rates were similar between patients receiving induction chemotherapy plus concurrent radiochemotherapy and those receiving concurrent radiochemotherapy （OR=0. 875, 95% CI 0.507-1.510, P=0. 631;HR=0.770, 95% CI 0.515-1.151, P=0. 203;HR=0.809, 95% CI 0.559- 1. 172, P=0. 262）, but the patients receiving induction chemotherapy plus concurrent radiochemotherapy showed a significantly higher incidence rate of grade ≥ 3 leukopenia than those receiving concurrent radiochemotherapy alone （ OR= 0. 637, 95% CI 0. 435-0. 931, P= 0. 020 ）. Conclusions Induction chemotherapy plus concurrent radiochemotherapy shows no significant advantages over concurrent radiochemotherapy alone in the short-term outcome and 2-and 3-year survival rates, but it significantly increases myelosuppression. Since there are few studies involving a limited number of cases included in this analysis, more multicenter randomized trials are needed to provide more detailed data and further clarify the clinical value of induction chemotherapy plus concurrent radiochemotherapy.