紫杉醇联合奥沙利铂对比紫杉醇联合顺铂治疗中晚期非小细胞肺癌疗效和安全性评价的Meta分析

Paclitaxel/oxaliplatin versus paclitaxel/cisplatin for advanced non-small cell lung cancer：a Meta analysis of randomized controlled trial

摘要:

目的：系统评价紫杉醇（paclitaxel）联合奥沙利铂（oxaliplatin）（PO方案）与紫杉醇联合顺铂（cisplatin）（PC方案）治疗中晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）的安全性和临床疗效。方法：计算机检索Cochrane Library、Pubmed、EMbase、Web of Science、CNKI、CBM-disc、VIP、万方数据等数据库中关于对比PC和PO治疗中晚期NSCLC疗效的随机对照试验（randomized controlled trial，RCT）。截止时间设为2013年10月。由2位研究者独立进行文献筛选、资料提取和方法学质量评价后，采用RevMan 5.0 软件进行Meta 分析。结果：共纳入14篇RCT（929例患者）。PC方案和PO方案在客观缓解率（RR=1.10，95%CI=0.91～1.32，P=0.33）、疾病控制率（RR=1.02，95%CI=0.93～1.11，P=0.65）、1年生存率（RR=1.03，95%CI=0.81～1.31，P=0.84）和脱发率（RR=0.96，95%CI=0.76～1.22，P=0.75）方面的差异无统计学意义。PC方案在白细胞减少（RR=0.66，95%CI=0.48～0.91）、消化道毒性（RR=0.37，95%CI=0.29～0.48）、肾毒性方面较PO方案明显（RR=0.10，95%CI=0.04～0.23）（P<0.05）。PO方案在神经毒性方面较PC方案明显（RR=3.73，95%CI=1.99～6.98）（P<0.05）。结论：PO方案与PC方案治疗中晚期NSCLC的疗效相当，但PO方案的毒副作用相对较低，可考虑作为诊疗指南与规范之外的一种超常规化疗方案。

Abstract:

Objective：To systematically evaluate the efficacy and acceptability of paclitaxel plus cisplatin（PC） and paclitaxel plus ox－aliplatin（PO） for treating patients with advanced non-small cell lung cancer. Methods：PubMed，Cochrane Library，Embase，Web of Science，CNKI，CBM-disc，VIP and WanFang Data were searched up to October 2013. Randomized controlled trials（RCTs） of PC versus PO for trearing advanced non-small cell lung cancer were extracted，reviewed，and validated according to the study protocol by two reviewers independently. Results：Fourteen RCTs involving 929 patients were included. The pooled results indicated that PC and PO had comparable efficacy concerning overall response rate（RR=1.10，95%CI=0.91 to 1.32，P=0.33），disease control rate（RR=1.02，95%CI=0.93 to 1.11，P=0.65），one-year survival rate（RR=1.03，95%CI=0.81 to 1.31，P=0.84） and alopecia rate（RR=0.96，95%CI=0.76 to 1.22，P=0.75）. Leucopenia，gastrointestinal and kidney toxicity were more serious in PC（P<0.05）. Neuritis toxicity was more serious in PO（P<0.05）. Conclusion：PO had the same efficacy as PC in treating mid-advanced non-small cell lung cancer，but its toxic effect is milder，and could be considered as supernormal chemotherapy besides the conventional guideline and norm. Simultane－ously，research advances in this field should be continued to make the results more reasonable.