亚肺叶切除联合^(125)I粒子植入治疗早期肺癌有效性的Meta分析与系统评价

Meta-analysis and system evaluation of ^(125)I implantation in the treatment of early lung cancer

目的评价亚肺叶切除(SR)联合^(125)I粒子植入(SRB)治疗不宜行根治性肺叶切除的早期非小细胞肺癌(NSCLC)患者的有效性。方法电子检索Pub Med、Embase、Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库,文献检索起止时间均从建库至2016年11月,同时检索纳入文献的参考文献,纳入探讨SR与SRB治疗早期肺癌有效性的临床研究,并逐个进行质量评价,归类分析及资料提取。结果共纳入16个研究(n=1 354例)。4个研究(n=612例)比较了SRB对比单独SR治疗早期肺癌的疗效,M eta分析结果显示,SRB虽然有提高SR术后患者局部控制率的趋势,但二者之间差异无统计学意义(P=0.06)。12个单臂研究(n=742)描述了SRB治疗早期肺癌的疾病控制情况,结果显示,患者局部控制率高达96.1%,区域复发或远处转移率为19.1%,1、2、5年的平均生存率分别是84.9%、74.0%、32.1%。结论综合现有资料,SRB是治疗早期NSCLC的有效策略,有降低患者局部复发率的趋势。但目前所纳入研究的证据级别较低,有待进一步开展高质量的临床研究。

Objective To evaluate the efficacy of sublobar resection（ SR） and sublobar resection combined w ith125 I brachytherapy（ SRB） in the treatment of early non-small cell lung cancer（ NSCLC）. Methods The relevant literatures on SR and SRB in the treatment of NSCLC w ere searched in Pub M ed,Embase,Cochrane Library,CNKI,Wanfang database,and Chinese CBM database from the inception date to Nov. 2016. The bibliographies of retrieved articles w ere also enrolled. The studies enrolled w ere classified,the quality w as evaluated,and data w ere extracted. Results A total of 16 studies（ n = 1 354） w ere included,4 of w hich compared the efficacy of SR and SRB in the treatment of NSCLC,and 12（n = 742） recorded SRB in the treatment of NSCLC. Meta-analysis showed that there was no statistical difference although SRB could reduce local recurrence（ P = 0. 06）. For SRB,the local control rate w as 96. 1%; the probability of local recurrence/distant metastases w as 19. 1%; the mean survival rate of 1-year,2-year and 5-year w as 84. 9%,74. 9%and 32. 1%,respectively. Conclusion The evidence show s that SRB is effective in the treatment of NSCLC,w hich can reduce the local recurrence rate. How ever,more high-quality studies are needed to confirm the efficacy.