比较吉非替尼与化疗一线治疗晚期非小细胞肺癌的Meta分析

目的 评价吉非替尼对比以铂类为基础的联合化疗一线治疗晚期非小细胞肺癌（NSCLC）的疗效与安全性。方法 检索PubMed、EMbase、中国生物医学文献数据库和中国知网等数据库，纳入吉非替尼对比铂类联合第3代化疗药物一线治疗晚期NSCLC的随机对照研究，检索时间截止于2012年3月，采用Stata 10.0软件进行Meta分析。结果 最终纳入4项研究，共1926例患者。在表皮生长因子受体（EGFR）突变阳性的人群中，吉非替尼在无进展生存期（HR=0.43，95％CI：0.32～0.58，P＜0.001）和有效率（71.5％ vs.38.1％，OR=4.04，95％CI：2.90～5.61，P＜0.001）方面均优于化疗组，在总生存期方面两组差异无统计学意义（HR=0.93，95％CI：0.75～1.15，P=0.492）。在安全性方面，吉非替尼主要为皮疹、腹泻和肝功能损害；化疗为中性粒细胞减少、血小板减少和贫血。结论 吉非替尼一线治疗晚期NSCLC具有一定优势，可作为EGFR敏感突变者的一线用药选择。

Gefitinib versus chemotherapy in the first-line treatment of advanced non-small cell lung cancer: a meta-analysis

Objective To assess the efficacy and safety of gefitinib versus platinum-based chemotherapy for patients with ad- vanced non-small cell lung cancer（NSCLC）. Methods Such databases as PubMed, Embase, CBM and CNKI were searched to col- lect the randomized controlled trials comparing gefitinib to platinum-based third-generation chemotherapy as the first-line treatment of advanced NSCLC published before March of 2012. Stata 10. 0 software was used for meta-analysis. Results Four studies involving 1926 patients were included. The result of recta-analysis showed that in patients with known epidermal growth factor receptor（EGFR） mutations or whose tumors likely to harbor a mutation, gefitinib was better than chemotherapy in progress free survival and effective rate （HR=0.43, 95%CI：0, 32-0. 58, P〈0.001; 71.5% vs. 38.1% , OR =4.04, 95%CI：2.90-5.61 , P〈0.001） , and there was no significant difference between the two groups in the overall survival （ HR = 0. 93, 95% CI：0. 75-1. 15, P = 0. 492 ）. In the aspect of safety, the major adverse events for gefitinib were rash, diarrhea and aminotransferase elevation, whereas platinum-based chemotherapy was associated with more neutropenia, anemia and thromboeytopenia. Conclusion Gefitinib shows more superiority and can be used as the first-line drug for EGFR-mutated advanced NSCLC.