欧美和亚裔人群放射性肺炎发生率Meta分析

Meta-analysis of the incidence of radiation pneumonitis between European, American and Asian populations

目的比较欧美和亚裔人群肺癌患者放射性肺炎(RP)发生率的差异。方法计算机检索PubMed、Embase、Cochrane library数据库,检索与肺癌和RP相关研究,根据研究开展所在地不同将检出研究分为亚洲地区与欧美澳地区研究两类,分别汇总RP发生率数据;在PubMed数据库检索与剂量学参数相关的研究。结果14项研究共3190例患者纳入分析,Meta分析结果显示亚洲地区和欧美澳地区患者≥3级RP发生率相近(4.9%∶4.6%,P=0.895),而5级RP发生率亚洲地区患者显著高于欧美澳地区患者(1.5%∶0.2%,P=0.002),且亚洲组研究中患者肺受量较低。21项研究报道了肺V20Gy剂量限定标准,进一步分析发现两地区研究间肺V20Gy剂量限定标准未达到统计学差异(P=0.440),亚洲地区研究的肺受量限定可能更为严格。结论亚洲地区肺癌患者较欧美澳地区患者在放化疗后发生RP概率较高;将单纯基于国外患者研究数据制定的胸部放疗方案应用于亚洲地区患者时,要注意剂量限定标准的差异。

Objective To compare the incidence of radiation pneumonitis(RP)between lung cancer patients from the European,American and Asian regions.Methods The studies related to lung cancer and RP were searched from PubMed,Embase,and Cochrane library.According to the different places where the studies were conducted,the searched studies were divided into two types:Asian studies and European,American and Australian studies.The incidence of RP between two regions was summarized.Studies related to dosimetry parameters were searched from PubMed database.Results A total of 3,190 patients from 14studies were included.Meta-analysis results showed that the incidence of≥grade 3 RP was similar in patients from Asia and Europe,America and Australia(4.9%vs.4.6%,P=0.895),whereas the incidence of grade 5 RP in Asia was significantly higher than that in Europe,America and Australia(1.5%vs.0.2%,P=0.002).Moreover,the lung irradiation dose received by the patients in the Asian group was relatively low.Lung V20Gy dose limitation standard was reported in 21studies.Further analysis found no statistical significance in lung V20Gy dose limitation standard between two regions(P=0.440),and the standard in Asian studies is likely to be even stricter.Conclusions The incidence of RP after chemoradiotherapy in lung cancer patients in Asia is relatively higher compared with those in Europe,America and Australia.The differences in dose limitation standard should be noted when the thoracic radiation regimen based solely on the data from foreign studies is applied to the patients in Asia.