阿帕替尼联合多西他赛治疗晚期非小细胞肺癌疗效及安全性的meta分析

Efficacy and safety of apatinib combined with docetaxel in the treatment of advanced non-sniall cell lung cancer:meta-analysis

目的系统评价阿帕替尼联合多西他赛治疗晚期非小细胞肺癌疗效及安全性。方法计算机检索中国期刊全文数据库、维普科技期刊、万方医学网、PubMed、Cochrane图书馆以及EMbase等数据库,通过检索词“阿帕替尼”“多西他赛”“非小细胞肺癌”“Apatinib”“Docetaxel”“non-smallcelllungcancer”“NSCLC”,搜索所有关于阿帕替尼联合多西他赛治疗晚期非小细胞肺癌的研究进行荟萃分析,检索时间为建库至2019年9月。由两位研究人员严格根据纳入标准、排除标准,独立筛选文献,获取数据以及评价质量后,采用Revman52软件进行meta分析。结果共纳入12篇研究,共699例晚期非小细胞肺癌患者,包括对照组351例、试验组348例。meta分析结果显示:试验组的客观缓解率、疾病控制率以及无进展生存期均显著优于对照组,差异均有统计学意义(RR=199,95%CI:150~264,P<001;RR=157,95%CI:136~183,P<001;HR=028,95%CI:025~032,P<001)。在不良反应中,试验组与对照组患者发生骨髓抑制反应(OR=121,95%CI:086~169,P=027)、高血压(OR=092,95%CI:047~182,P=015)、腹泻(OR=114,95%CI:053~245,P=073)、恶心呕吐(OR=092,95%CI:047~182,P=081)以及手足综合征发生概率(OR=155,95%CI:089~272,P=012)相似,差异均无统计学意义。结论阿帕替尼联合多西他赛治疗晚期非小细胞肺癌可改善患者客观缓解率、疾病控制率以及无进展生存期,具有较好的临床疗效,并且不良反应相对较少,具有一定的临床应用价值。由于纳入研究的质量及样本量受限,上述结论尚需开展更多高质量、大样本研究予以验证。

Objective To systematically evaluate the efficacy and safety of apatinib combined with docetaxel in the treatment of advanced non-small cell lung cancer.Methods Computer retrieval of the Chinese journal full-text database(CNKI),V IP,wanfang,PubMed,Cochrane library and EM base,conducted a meta-analysivS of studies about apatinib combined with docetaxel in the treatment of advanced NSCLC by searching the words"Apatinib""Docetaxel""non-small cell lung cancer""NSCLC".The search was conducted until September,2019.Two authors read the literatures independently,acquired the data and evaluated the quality in strict accordance with the inclusion and exclusion criteria,RevmanS.2 software was used for Meta-analysis.Results A total of 12 studies were included,including 699 patients with advanced N SC LC,including 351 patients in the control group and 348 patients in the experimental group.The result revealed that the objective response rate,disease control rate and progression-free survival were significantly better than the control group(RR=1.99,95%CI:1.50-2.64,P<0.01,RR=1.57,95% CI:1.36-1.83,P<0.01,HR=0.28,95%CI:0.25-0.32,P<0.01),and the difference was statistically significant.In terms of adverse reactions,there was no significant difference in myelosuppression(OR=1.21,95%CI:0.86-1.69,P=0.27),hypertension(OR=0.92,95%CI:0.47-1.82,P=0.15),diarrhea(OR=1.14,95%CI:0.53-2.45,P=0.73),nausea and vomiting(OR=0.92,95%CI:0.47-1.82,P=0.81),and hand-foot syndrome(OR=1.55,95%CI:0.89-2.72,P=0.12)between the experimental group and control group.Conclusions Apatinib combined with docetaxel in the treatment of advanced non-small cell lung cancer has a good clinical effect,which can improve the objective remission rate,disease control rate and progression-free survival of patients with advanced NSCLC,and fewer adverse reactions.Because of the limited sample size and quality of the included studies,the above conclusions need to be verified by more high-quality and large-sample studies.