吉西他滨联合顺铂治疗晚期非小细胞肺癌的系统评价再评价

Reevaluation of systematic evaluation of gemcitabine combined with cisplatin in the treatment of advanced non-small cell lung cancer

目的再评价吉西他滨联合顺铂治疗晚期非小细胞肺癌(NSCLC)的系统评价,以期为NSCLC的治疗提供循证依据。方法计算机检索万方数据库、中国知网、维普网、PubMed和Embase,纳入吉西他滨联合顺铂对比培美曲塞/长春瑞滨联合顺铂治疗晚期NSCLC的系统评价,检索时限为各数据库建库起至2021年12月。采用RevMan 5.3系统评价软件对各项结局指标进行Meta分析;方法学质量评价采用AMSTAR2量表,证据质量评价采用GRADE工具。结果共纳入9篇文献,Meta分析结果显示,吉西他滨联合顺铂的有效率显著低于培美曲塞联合顺铂,但与长春瑞滨联合顺铂相当;吉西他滨联合顺铂的1年生存率与培美曲塞联合顺铂相当,但显著高于长春瑞滨联合顺铂;吉西他滨联合顺铂的恶心呕吐发生率与培美曲塞/长春瑞滨联合顺铂相当;吉西他滨联合顺铂的血小板减少发生率显著高于培美曲塞/长春瑞滨联合顺铂;吉西他滨联合顺铂的中性粒细胞减少发生率和白细胞减少发生率均高于培美曲塞联合顺铂,但显著低于长春瑞滨联合顺铂。AMSTAR2量表评价结果显示,6篇系统评价为方法学低质量,3篇为极低质量。GRADE工具分级结果显示,结局指标中的中等质量证据占31%(14项),低质量证据占27%(12项),极低质量证据占42%(19项);研究的局限性及发表偏倚是降级的主要因素。结论吉西他滨联合顺铂治疗晚期NSCLC的有效性与安全性较长春瑞滨联合顺铂有优势,特别是在1年生存率、中性粒细胞减少发生率和白细胞减少发生率方面;吉西他滨联合顺铂的有效性与安全性不优于培美曲塞联合顺铂。但考虑到纳入系统评价的方法学质量和证据等级,其整体研究质量还有待提高。

OBJECTIVE To reevaluate the systematic evaluation of gemcitabine combined with cisplatin in the treatment of advanced non-small cell lung cancer(NSCLC),in order to provide evidence-based evidence for the treatment of NSCLC.METHODS Retrieved from Wanfang database,CNKI,VIP,PubMed,Embase,systematic evaluation of gemcitabine combined with cisplatin versus pemetrexed/vinorelbine combined with cisplatin in the treatment of advanced NSCLC was included from the inception to Dec.2021.RevMan 5.3 system evaluation software was used for meta-analysis of various outcome indicators;AMSTAR2 scale was used for methodological quality evaluation,and GRADE tool was used for evidence quality evaluation.RESULTS A total of 9 literatures were included.Meta-analysis showed that the effective rate of gemcitabine combined with cisplatin was significantly lower than pemetrexed combined with cisplatin,but was similar to vinorelbine combined with cisplatin.The 1-year survival rate of gemcitabine combined with cisplatin was equivalent to that of pemetrexed combined with cisplatin,but was superior to vinorelbine combined with cisplatin.There was no significant difference in the incidence of nausea and vomiting between gemcitabine combined with cisplatin and pemetrexed/vinorelbine combined with cisplatin.Gemcitabine combined with cisplatin had a higher incidence of thrombocytopenia than pemetrexed/vinorelbine combined with cisplatin.The incidence of neutropenia and leukopenia in gemcitabine combined with cisplatin were higher than pemetrexed combined with cisplatin,but were significantly lower than vinorelbine combined with cisplatin.The evaluation results of AMSTAR2 scale showed that 6 systematic evaluation were of low quality in methodology and 3 were of very low quality.The results of the GRADE tool showed that 31%of the outcome indicators were of medium quality(14 items),27%were of low quality(12 items),and 42%were of very low quality(19 items).Research limitations and publication bias were the most frequently downgraded factors.CONCLUSIONS Gemcitabine combined with cisplatin has advantages over vinorelbine combined with cisplatin in the efficacy and safety of advanced NSCLC,especially in the 1-year survival rate,the incidence of neutropenia and leucopenia.The efficacy and safety of gemcitabine combined with cisplatin are inferior to those of pemetrexed combined with cisplatin.However,the methodological quality and evidence level of systematic evaluation are not high on the whole,and the overall quality of research needs to be improved.