恩度联合顺铂治疗非小细胞肺癌合并恶性胸腔积液的Meta分析

Efficacy and Safety of Endostar Combined with Cisplatin in Treatment of Non-Small Cell Lung Cancer with Malignant Pleural Effusion:A Meta-analysis

目的系统评价恩度联合顺铂胸腔内注射治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)合并恶性胸腔积液的有效性及安全性。方法计算机检索PubMed、The Cochrane Library(2016年2期)、EMbase、Web of Science、CNKI、VIP和WanFang Data数据库,搜集恩度联合顺铂胸腔内注射治疗NSCLC合并恶性胸腔积液的相关随机对照试验(RCT),检索时限均为从建库至2016年2月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入10个RCT,共610例患者,Meta分析结果显示:恩度联合顺铂组的总有效率[RR=1.71,95%CI(1.49,1.95),P<0.000 01]和生活质量改善率[RR=1.68,95%CI(1.44,1.96),P<0.000 01]明显高于单药顺铂组。但两组胃肠道反应发生率[RR=1.13,95%CI(0.84,1.52),P=0.40]、白细胞减少发生率[RR=1.11,95%CI(0.84,1.49),P=0.46]及血小板减少发生率[RR=1.40,95%CI(0.85,2.30),P=0.18]差异无统计学意义。结论与单药顺铂相比,恩度联合顺铂胸腔内注射治疗NSCLC合并恶性胸腔积液,能提高患者的总有效率,改善患者的生活质量,具有良好的疗效及安全性。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of intrapleural injection of endostar combined with cisplatin in treatment of non-small cell lung cancer （NSCLC） with malignant pleural effusion. Methods Databases including PubMed, The Cochrane Library （Issue 2, 2016）, EMbase, Web of Science, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials （RCTs） about endostar combined with cisplatin for NSCLC with malignant pleural effusion from inception to February 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 10 RCTs involving 610 patients were finally included. The results of meta- analysis showed that： The overall response rate and the improvement rate of quality of life in the endostar combined with cisplatin group were higher than that of the cisplatin alone group （RR=I.71, 95%CI 1.49 to 1.95, P〈0.000 01; RR=l.68, 95%CI 1.44 to 1.96, P〈0.000 01, respectively）. However, There were no significant differences between two groups in incidence of gastrointestinal reaction, incidence of leucopenia and incidence of thrombocytopenia （all P values〉0.05）. Conclusion Compared with cisplatin, intrapleural injection of endostar combined with cisplatin can improve the overall response rate and improve the quality of life of NSCLC patients with malignant pleural effusion. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.