培美曲塞与多西紫杉醇二线治疗晚期非小细胞肺癌的Meta分析

摘要

目的：通过系统评价的方法比较培美曲塞单药和多西紫杉醇单药二线治疗晚期非小细胞肺癌（NSCLC）的疗效与安全性。方法通过Cochrane系统评价的方法，收集文献进行评价与筛选，数据提取，采用 RevMan5．0进行数据分析。结果共纳入9篇研究，1439例患者。Meta分析结果提示：晚期 NSCLC的二线治疗中，培美曲塞与多西紫杉醇相比，治疗有效率（RR＝1．26，95％CI：0．93～1．71，P＝0．14），疾病控制率（RR＝0．97，95％CI：0．88～1．06，P＝0．49）及1年生存率（RR＝0．98，95％CI：0．81～1．19，P＝0．87）差异均无统计学意义；对于Ⅲ～Ⅳ级中性粒细胞减少（RR＝0．17，95％CI：0．12～0．23，P＜0．01），血小板减少（RR＝7．01，95％CI：1．87～26．29，P＝0．004）]，中性粒细胞性发热（RR＝0．19，95％CI：0．07～0．52，P＜0．01），脱发（RR＝0．09，95％CI：0．01～0．7，P＝0．02）及腹泻（RR＝0．12，95％CI：0．02～0．65，P＝0．01）不良反应，培美曲塞较多西紫杉醇轻。其他不良反应差异无统计学意义（P＞0．05）。结论培美曲塞与多西紫杉醇在晚期 NSCLC二线治疗中疗效相当，但培美曲塞的安全性更好。%Objective Evaluating the efficacy and safety of pemetrexed alone versus docetaxel alone in second-line treatment of patients with advanced non-small cell lung cancer(NSCLC).Methods Followed by literature collection,assessment,data collection and extraction according Cochrane handbook for systematic reviews,and data analysis were performed by RevMan 5 .0 software.Re-sults 9 studies involving 1 439 cases were included.The results of Meta-analysis showed that for second-line treatment of advanced NSCLC,in efficacy part,there was no statistical difference between the two group in the effective rate(RR=1.26,95%CI:0.93-1.71,P=0.14),the disease control rate(RR=0.97,95%CI:0.88-1.06,P=0.49)and 1-year survival rate(RR=0.98,95%CI:0.74-1.29,P=0.87);in safety part,pemetrexed has a mild toxicity compare with docetaxel in Ⅲ-Ⅳ grade neutropenia(RR=0.17,95%CI:0.12-0.23,P<0.01),thrombocytopenia(RR=7.01,95%CI:1.87-26.29,P=0.004),the febrile neutropenia (RR=0.19,95%CI:0.07-0.52,P<0.01),alopecia[RR=0.09,95%CI:0.01-0.7,P=0.02]and diarrhea(RR=0.12,95%CI:0.02-0.65,P=0.01).There was no statistical difference in other adverse reactions(P>0.05).Conclusion Pemetrexed showed an equivalent efficacy to docetaxel in the second-line treatment of patients with advanced NSCLC,but it has better security.