甲磺酸奥希替尼治疗EGFR突变型非小细胞肺癌的效果meta分析

Meta analysis of efficacy of osimertinib mesylate in the treatment of EGFR mutant non-small cell lung cancer

目的对甲磺酸奥希替尼治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)突变型非小细胞肺癌(non small cell lung cancer,NSCLC)的效果进行meta分析。方法纳入国内外各数据库从建库至2022年5月公开发表的甲磺酸奥希替尼治疗EGFR突变型NSCLC随机对照试验(randomized controlled trial,RCT)文献,采用RevMan5.2软件对其效果实施meta分析。结果共纳入7篇文献,其中2篇中文报道,5篇英文报道,共2591例患者;甲磺酸奥希替尼治疗的试验组共1385例,采用化疗或吉非替尼或厄洛替尼治疗的对照组共1206例,纳入的文献质量均达标;临床获益率、总有效率文献有异质性(I^(2)=62%、P=0.02;I^(2)=65%、P=0.04)随机效应模型分析,差异无统计学意义(RR=0.08,95%CI:-0.12~0.14,P=0.159;RR=0.04,95%CI:-0.02~0.11,P=0.136);无进展生存期(progression free survival,PFS)、总生存期(overall survival,OS)、生存率、中位缓解持续时间(median duration of remission,mDOR)文献无异质性(I^(2)=41%、P=0.26;I^(2)=36%、P=0.31;I^(2)=25%、P=0.63;I^(2)=18%、P=0.72),试验组PFS、OS、mDOR均较对照组延长(WMD=4.38,95%CI:4.25~4.46,P<0.001;WMD=3.97,95%CI:3.82~4.09,P<0.001;WMD=3.36,95%CI:3.14~3.58,P<0.001),且试验组生存率较对照组高(WMD=2.57,95%CI:2.25~2.78,P<0.001),均未见发表偏倚风险。结论与化疗或吉非替尼或厄洛替尼治疗相比,甲磺酸奥希替尼治疗EGFR突变型NSCLC患者可延长PFS、OS及mDOR,提高生存率。

Objective To evaluate the efficacy of osimertinib mesylate in the treatment of epidermal growth factor receptor(EGFR)mutant non-small cell lung cancer(NSCLC)by Meta analysis.Methods The literature of randomized controlled trial(RCT)of osimertinib mesylate in the treatment of EGFR mutant NSCLC published in the well-known domestic and foreign databases from the establishment of the database to May 2022 were included,and RevMan5.2 software was used to perform meta-analysis on its effect.Results A total of 7 articles were included,including 2 reports in Chinese and 5 reports in English,with a total of 2591 patients.There were 1385 cases in the experiment group treated with osimertinib mesylate and 1206 cases in the control group treated with chemotherapy or gefitinib or erlotinib.The quality of the included articles was up to the standard.The literature on clinical benefit rate and total effective rate was heterogeneous(I^(2)=62%,P=0.02;I^(2)=65%,P=0.04).Random effects model analysis showed no significant difference(RR=0.08,95%CI:-0.12-0.14,P=0.159;RR=0.04,95%CI:-0.02-0.11,P=0.136).There were no heterogeneity in progression free survival(PFS),overall survival(OS),survival,and median duration of remission(mDOR,I^(2)=41%,P=0.26;I^(2)=36%,P=0.31;I^(2)=25%,P=0.63;I^(2)=18%,P=0.72).The PFS,OS and mDOR in the experiment group were longer than those in the control group(WMD=4.38,95%CI:4.25-4.46,P<0.001;WMD=3.97,95%CI:3.82-4.09,P<0.001;WMD=3.36,95%CI:3.14~3.58,P<0.001),and the survival rate of the experiment group was higher than that of the control group(WMD=2.57,95%CI:2.25-2.7,P<0.001).There was no risk of publication bias.Conclusion Compared with chemotherapy or gefitinib or erlotinib,osimertinib mesylate can prolong PFS,OS,mDOR and improve survival rate in patients with EGFR mutant NSCLC.