铂类联合多西他赛或长春瑞滨一线治疗晚期非小细胞肺癌的meta分析

摘要

背景与目的以铂类为基础联合第三代药物的双药化疗方案是治疗晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）的标准一线治疗方案。本研究采用meta分析的方法评价多西他赛联合铂类（docetaxel plus platinum, DP）方案对比长春瑞滨联合铂类（vinorelbine plus platinum, VP）方案治疗晚期NSCLC的疗效和安全性。方法计算机检索Pubmed、EMBASE、Cochrane Library、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、中文科技期刊全文数据（VIP）库及万方数据库关于DP方案与VP方案治疗晚期NSCLC的随机对照试验（randomized controlled trial, RCT）。根据Cochrane Handbook 5.1.0的质量评价标准，用Stata 12.0软件进行统计学分析。结果研究共纳入7项RCTs，包括晚期NSCLC患者2,381例。DP方案的2年生存率（HR=0.887,95%CI：0.810-0.972, P=0.010）、有效率（RR=1.276,95%CI：1.107-1.450, P=0.001）和腹泻发生率（RR=3.134,95%CI：1.918-5.121, P<0.001）较VP方案高；DP方案减少了贫血的发生率（RR=0.386,95%CI：0.311-0.478, P<0.001）；DP方案与VP方案在1年生存率、白细胞减少、中性粒细胞减少、血小板减少、厌食、恶心、呕吐方面的差异无统计学意义。结论 DP方案虽然增加了腹泻发生率，但却减少了贫血的发生率，同时提高了2年生存率和有效率。相比VP方案，DP方案可能更适合一线治疗晚期NSCLC。%Background and objective Platinum plus a third-generation agent doublet chemotherapy is the stan-dard regimen and ifrst-line chemotherapy for the treatment of advanced non-small cell lung cancer (NSCLC). hTe aim of this study is to evaluate the effcacy and safety of docetaxel plus platinum (DP) compared with vinorelbine plus platinum (VP) regimens in patients with advanced NSCLC. Methods We searched the PubMed, EMBASE, Cochrane Library, CNKI, CBM, VIP, and WanFang databases for randomized controlled trials (RCTs), in which DP regimen was compared with VP regimen. A quality assessment of qualiifed RCTs was performed according to Cochrane Handbook 5.1.0, and Stata 12.0 was used to per-form meta-analysis. Results Seven RCTs involving 2,318 patients were included. Meta-analysis results indicated that the DP regimen increased the two-year survival rate (HR=0.887, 95%CI:0.810-0.972, P=0.010), response rate (RR=1.276, 95%CI:1.107-1.450, P=0.001), and diarrhea rate (RR=3.134, 95%CI:1.918-5.121, P<0.001) compared with the VP regimen. Anemia rate was also reduced (RR=0.386, 95%CI:0.311-0.478, P<0.001). No statistical differences were observed between DP and VP regimens in terms of one-year survival rate, leukopenia, neutropenia, thrombocytopenia, anorexia, nausea, and vomiting. Conclusion DP regimen reduced the rate of anemia and increased the rate of diarrhea, two-year survival rate, and response rate. hTerefore, DP regimen may be a more effective option as a ifrst-line treatment for advanced NSCLC compared with VP regimen.