奈达铂或顺铂联合紫杉醇治疗晚期非小细胞肺癌和食管癌的系统评价

摘要

OBJECTIVE:To systematically review the efficacy and safety of nedaplatin or cisplatin combined with paclitaxel in the treatment of advanced non-small cell lung cancer(NSCLC)and esophageal cancer. METHOD:Retrieved from PubMed,CJFD and Wanfang Database,randomized controlled trials(RCT)about nedaplatin combined with paclitaxel(TN)or cisplatin combined with paclitaxel (TP) in the treatment of advanced NSCLC and esophageal cancer were collected. Meta-analysis was performed by using Rev Man 5.3 software after data extract and quality evaluation. RESULTS:Totally 7 RCTs were included,involving 505 pa-tients. Results of Meta-analysis showed,there were no significant differences in the short-term efficacy [NSCLC:OR=1.08,95%CI (0.66,1.75),P=0.76;esophageal cancer:OR=1.44,95%CI(0.68,3.06),P=0.34],1-year survival rate [NSCLC:OR=1.21, 95%CI(0.60,2.44),P=0.59],2-year survival rate [NSCLC:OR=1.01,95%CI(0.38,2.68),P=0.99],the incidence ofⅢ/Ⅳleuko-penia [esophageal cancer:OR=1.36,95%CI(0.62,2.96),P=0.44],incidence ofⅢ/Ⅳthrombocytopenia [NSCLC:OR=1.37,95%CI(0.64,2.92),P=0.42;esophageal cancer:OR=0.97,95%CI(0.30,3.18),P=0.96] and incidence of Ⅲ/Ⅳ neutropenia [NSCLC:OR=1.38,95%CI(0.70,2.74),P=0.35]. Compared with TP,TN can significantly reduce the incidences of nausea and vomiting [NSCLC:OR=0.34,95%CI(0.20,0.60),P<0.001;esophageal cancer:OR=0.16,95%CI(0.07,0.35),P<0.001] and nephrotox-icity [esophageal cancer:OR=0.10,95%CI(0.02,0.55),P=0.009]. CONCLUSIONS:Both TN and TP show good efficacy in the treatment of NSCLC,but TN has lower incidences of astrointestinal reactions and nephrotoxicity.%目的：系统评价奈达铂或顺铂联合紫杉醇治疗晚期非小细胞肺癌（NSCLC）和食管癌的疗效与安全性。方法：计算机检索PubMed、中国期刊全文数据库、万方数据库，纳入奈达铂联合紫杉醇（TN方案）或顺铂联合紫杉醇（TP方案）治疗晚期NSCLC及食管癌的随机对照试验（RCT），对纳入研究进行资料提取和质量评价后采用Rev Man 5.3统计软件进行Meta分析。结果：共纳入7项RCT，合计505例患者。Meta分析结果显示，两种方案在近期疗效[NSCLC：OR＝1.08，95％CI（0.66，1.75），P＝0.76；食管癌：OR＝1.44，95％CI（0.68，3.06），P＝0.34]、1年生存率[NSCLC：OR＝1.21，95％CI（0.60，2.44），P＝0.59]、2年生存率[NSCLC：OR＝1.01，95％CI（0.38，2.68），P＝0.99]、Ⅲ/Ⅳ度白细胞下降发生率[食管癌：OR＝1.36，95％CI（0.62，2.96），P＝0.44]、Ⅲ/Ⅳ度血小板下降发生率[NSCLC：OR＝1.37，95％CI（0.64，2.92），P＝0.42；食管癌：OR＝0.97，95％CI（0.30，3.18），P＝0.96]、Ⅲ/Ⅳ度中性粒细胞下降发生率[NSCLC：OR＝1.38，95％CI（0.70，2.74），P＝0.35]等方面比较差异均无统计学意义。但与TP方案相比，TN方案可显著降低患者恶心呕吐发生率[NSCLC：OR＝0.34，95％CI（0.20，0.60），P＜0.001；食管癌：OR＝0.16，95％CI（0.07，0.35），P＜0.001]和肾毒性发生率[食管癌：OR＝0.10，95％CI（0.02，0.55），P＝0.009]。结论：TN方案与TP方案治疗晚期NSCLC和食管癌疗效相当，但TN方案发生胃肠道反应及肾毒性的几率更低。