易瑞沙与二线化疗治疗一线化疗失败的晚期非小细胞肺癌疗效meta分析

摘要

目的:比较易瑞沙和二线化疗治疗一线化疗失败的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效和毒性反应.方法:计算机检索pubmed、EMBASE、维普数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库等中外文数据库,检索时间至2010年12月30日;同时辅助其它检索,纳入易瑞沙和二线化疗治疗一线化疗失败的晚期NSCLC的随机对照试验(randomized controlled trials,RCTs),两名评价者独立评价纳入研究的质量并提取资料,用RevMan 5.0软件进行统计分析.结果:共纳入4篇RCTs,meta分析结果显示:与二线化疗组相比,易瑞沙组治疗有效率(OR=0.99,95%CI:0.51-1.92,P=0.98)和1年生存率(OR=1.06,95%CI:0.53-2.09,P=0.87)无明显差别,但化疗后骨髓抑制率(OR=0.07,95%CI:0.03-0.77,P<0.00001)明显低于二线化疗组.结论:对于一线化疗失败的晚期NSCLC患者,可以根据患者治疗意愿和经济能力选取易瑞沙治疗或者二线化疗,但对于体质较差或化疗药物耐受性较差的患者,选用易瑞沙治疗不良反应较小.%Objective: To evaluate the efficacy and toxicity of Iressa compared with second - line chemotherapy in the treatment for chinese patients with non - small cell lung cancel NSCLC )who have failed previous chemotherapy. Methods: Relevant randomized controlled trials ( RCTs )from Pubmed,EMBASE,VIP,CBM and CNKI were searched until December 30,2010. RCTs of Iressa compared with second - line chemotherapy in the treatment for Chinese patients with NSCLC who have failed previous chemotherapy were included. The quality of these included studies and analyzed data were evaluated by Cochrane Collaborations RevMan 5. 0 software. Results: Four RCTs involving 217 patients were included. The Meta - analysis results suggested that compared with second - line chemotherapy group, the Iressa group had no significant difference in healing efficacy ( OR =0. 99,95%CI: 0.51 - 1. 92,P =0. 98 )and 1 year survival rate( OR = 1. 06,95% CI: 0.53 -2. 09,P =0.87 ). Besides,the Iressa group had a statistically significant benefit in myelosuppression( OR =0.07,95% CI: 0.03 -0.77,P ＜0. 00001 ). Conclusion: Iressa and second - line chemotherapy all can be used in the treatment for Chinese patients with NSCLC who have failed previous chemotherapy. Especially,Iressa should be used in patients with poor body constitution.