中药治疗Ⅲ～Ⅳ期肺癌含铂两药化疗患者癌因性疲乏的Meta分析

Meta analysis of Chinese medicine in the treatment of cancer-related fatigue in patients with stage Ⅲ～Ⅳ lung cancer treated with platinum containing two-drug chemotherapy

目的运用Meta分析的方法,评价中药治疗Ⅲ~Ⅳ期肺癌含铂两药化疗患者癌因性疲乏的临床疗效,为肺癌化疗患者癌因性疲乏的中药治疗提供科学依据。方法采取Cochrane系统综述方法,以"癌因性疲乏""肺癌""化疗"相关中英语词汇为关键词,检索中文数据库、外文数据库、肿瘤在研临床试验注册平台及相关学术组织网站等,从中二次检索采用中药联合含铂两药化疗治疗Ⅲ~Ⅳ期肺癌的癌因性疲乏状态的随机对照试验文献,检索时间截至2018-12。按照纳入排除标准选择文献、提取资料和进行质量评价后,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果共纳入7项随机对照试验,包括554例患者(观察组280例,对照组274例)。Meta分析结果表明,中药联合含铂两药化疗与单纯含铂两药化疗比较,针对Ⅲ~Ⅳ期肺癌患者,在缓解中重度癌因性疲乏[RR=1.85,95%CI(0.94,2.76)]、改善癌因性疲乏总有效率[RR=1.97,95%CI(0.10,3.84)]、增加卡氏功能状态评分(KPS)[RR=1.29,95%CI(0.86,1.72)]、提高恶性实体肿瘤治疗有效率[RR=1.26,95%CI(0.60,1.92)]方面比较差异有统计学意义(P<0.05)。结论现有证据表明,针对接受含铂两药化疗的Ⅲ~Ⅳ期肺癌患者,中药在改善癌因性疲乏状态、增加KPS及提高恶性实体肿瘤治疗有效率方面效果显著。但由于纳入研究样本量小且质量限制,上述结论尚需大规模、多中心、随机对照、全面系统、高质量的研究来加以证实。

Objective To evaluate the clinical efficacy of traditional Chinese medicine in the treatment of cancer-related fatigue in patients with stage Ⅲ-Ⅳ lung cancer treated with platinum containing two-drug chemotherapy, so as to provide scientific basis for the treatment of cancer-related fatigue in patients with lung cancer treated with traditional Chinese medicine. Methods Cochrane systematic review method was used to search Chinese database, foreign database, cancer in research clinical trial registration platform and related academic organization website, with Chinese and English words related to "cancer-related fatigue", "lung cancer" and "chemotherapy" as key words, the literature of randomized controlled trials on cancer-related fatigue of patients with stage Ⅲ ~ Ⅳ lung cancer treated with traditional Chinese medicine and platinum containing two-drug chemotherapy was searched for the second time, and the retrieval time was up to December 2018. After selecting literature, extracting data and evaluating quality according to the inclusion and exclusion criteria, the Revman 5.3 software provided by Cochrane collaboration network was used for meta analysis. Results A total of 7 randomized controlled trials were included, including 554 patients(280 in the observation group and 274 in the control group). The results of meta-analysis showed that the combination of traditional Chinese medicine and platinum containing two-drug chemotherapyy was more effective in relieving moderate and severe cancer-related fatigue [RR=1.85, 95% CI(0.94, 2.76)], improving the total effective rate of cancer-related fatigue [RR=1.97, 95% CI(0.10, 3.84)], increasing kappa’s score [RR=1.29,95%CI(0.86,1.72)], and improving the effective rate of treatment of malignant solid tumors [RR=1.26,95%CI(0.60,1.92)], the difference was statistically significant(P<0.05). Conclusion According to the existing evidence, traditional Chinese medicine has statistical significance in improving cancer-related fatigue, increasing KPS score and improving the treatment efficiency of malignant solid tumors in patients with stage Ⅲ ~ Ⅳ lung cancer receiving chemotherapy with platinum containing two-drug. However, due to the small sample size and limited quality, the above Conclusion s need to be confirmed by large-scale, multicenter, randomized control, comprehensive and systematic research with high quality.