WBRT±替莫唑胺对NSCLC脑转移疗效及安全性比较的Meta分析

Meta-analysis of efficiency and safety of WBRT±temozolomide in treatment of brain metastases from NSCLC

目的比较替莫唑胺(TMZ)联合全脑放疗(WBRT)与单纯WBRT治疗非小细胞肺癌(NSCL)脑转移灶疗效及安全性。方法按检索策略在EMbase、Cochrane、PubMed、万方、维普中文科技期刊数据库(VIP)、中国知网检索2018年2月前的中英文文献,按纳入标准及排除标准筛选出目标文献。3位研究者单独对纳入研究的质量进行评估及提取数据。RevMan 5.3及Stata 12软件进行统计分析,对研究的客观缓解率(ORR)、无进展生存(PFS)、总生存(OS)和化疗不良反应进行评估。结果共纳入17项研究共计1128例患者。Meta分析结果显示WBRT+TMZ组较WBRT组客观反应率高(OR=2.54,95%CI为1.93~3.36,P<0.001),PFS长(MSR=1.329,95%CI为1.143~1.545,P<0.001),血液反应的发生率(OR=3.44,95%CI为1.63~7.26,P<0.05)及胃肠道反应发生率(OR=1.69,95%CI为1.24~2.31,P<0.05)更多见,其异质性均在可接受范围内。OS结果因异质性较大而未能得到无争议结果。出现头痛反应相近(OR=1.05,95%CI为0.72~1.55,P=0.79)。结论WBRT联合TMZ治疗NSCLC脑转移患者,与单纯WBRT相比,有利于提高近期疗效,但血液及消化道反应更加常见但可控,头痛发生无明显差异。对远期的生存获益不确切。

Objective To compare the efficacy and safety between whole brain radiotherapy (WBRT) and WBRT combined with temozolomide (TMZ) in the treatment of non-small cell lung cancer with brain metastases. Methods According to the retrieval strategy, the Chinese and English literatures before February 2018 were retrieved from EMbase, Cochrane, PubMed, Wanfang database, Chongqing VIP and CNKI, The target literatures were selected according to the inclusion and exclusion criteria, The quality of the included studies and extracted data was independently assessed by 3 researchers, The RevMan 5, 3 and STATA 12, 0 software was used for statistical analysis, The objective remission rate (ORR), the total survival period (OS), the progression-free survival (PFS), and the side effects of chemotherapy were evaluated. Results In total, 17 trials consisting of 1128 patients were included, The results of Meta-analysis demonstrated that compared with the WBRT group, the ORR was significantly higher (OR=2.54;95%CI: 1.93-3.36;P<0.001), the PFS was significantly longer (MSR=1.329;95%CI: 1.143-1.545;P<0, 001), and the incidence of hematological toxicity (OR=3.44;95%CI: 1.63-7.26;P<0.05) and the gastric intestinal reaction (OR=1.69;95%CI: 1.24-2.31;P<0.05) was significantly higher in the WBRT+ TMZ group, The heterogeneities were within the acceptable range with statistical significance, The results of OS were invalid due to relatively large heterogeneity, The incidence of headache did not significantly differ between two groups (OR=1.05;95%CI: 0.72-1.55;P=0, 79). Conclusions Compared with WBRT alone, WBRT combined with TMZ is beneficial to improve the short-term efficacy, whereas the incidence of hematological toxicity and gastrointestinal reaction is higher, The occurrence of headache does not significantly differ between two groups, The benefit of long-term survival remains uncertain.