放疗与TKI治疗肺癌脑膜转移的Meta分析

Role for treatment of radiation and TKI in patients with leptomeningeal metastases from lung cancer: A Meta-analysis

目的:通过系统回顾和Meta分析,明确放疗和酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)治疗在肺癌脑膜转移的作用。方法:计算机检索Pubmed、EMBASE、Web of Science、Cochrane Library数据库中关于肺癌脑膜转移治疗的相关文献,采用Review Manager 5. 3和STATA MP14. 0两个软件进行统计分析,主要的研究终点是总生存期(overall survival,OS),采用危险比(hazard ratios,HR)和可信区间(95%CI)合并效应量。结果:最终纳入11篇文献,993例患者。放疗组OS显著优于非放疗组(HR:0. 65,95%CI:0. 52～0. 81,P<0. 001),TKI组的OS也显著优于非TKI组(HR:0. 3,95%CI:0. 24～0. 38,P <0. 001)。结论:放疗和TKI治疗能给肺癌脑膜转移患者带来潜在的生存获益。

Objective:To determine whether treatment of radiation(RT)and tyrosine kinase inhibitor(TKI)improve survival compared with treatment of non-RT and non-TKI for patients with leptomeningeal metastases from lung cancer.Methods:The PubMed,EMBASE,Web of Science,and Cochrane Library were searched for articles which related to treatment of lung cancer with leptomeningeal metastases.The main outcome was overall survival(OS)and was compared by hazard ratios(HR).Statistical analysis was performed using the software Review Manager 5.3 and STATA MP14.0.Results:11 retrospective studies that included a total of 993 patients were eligible.RT significantly improved OS compared with non-RT treatment(HR:0.65,95% CI:0.52~0.81,P<0.001),and TKI provided significant OS benefit compared with non-TKI treatment(HR:0.3,95% CI:0.24~0.38,P<0.001).Conclusion:Evidences from the current Meta-analysis suggested a potential OS benefit from RT and TKI treatment for patients with leptomeningeal metastases from lung cancer.Further prospective randomised controlled trials(RCT)are needed to confirm these findings.