胸腔化疗联合热疗治疗肺癌胸水有效性及安全性的系统评价

目的:系统评价胸腔化疗联合热疗治疗肺癌胸水的有效性及安全性。方法:系统检索Cochrane Library、PubMed、EMbase、Web of Science、CBM、CNKI、维普及万方等数据库，配合补充检索手段，收集所有比较胸腔化疗联合热疗与单一疗法的随机对照试验。逐步进行文献筛选和资料提取，评估纳入文献的偏倚风险，应用RevMan 5.3软件进行Meta分析。结果:共纳入23篇随机对照试验（1 329例患者）。有效性评价:联合组的总有效率、完全缓解率及生活质量改善率均高于单纯胸腔化疗组，且其差异均有统计学意义（P<0.05），其合并效应量分别为［OR=3.95，95%CI=(3.04，5.13)］、［OR=2.80，95%CI=(2.13，3.68)］、［OR=3.11，95%CI=(2.34，4.14)］。安全性评价:联合组的胸痛、白细胞下降、恶心呕吐、肾脏损害及发热的发生率均低于单纯胸腔化疗组，但只有胸痛发生率在两组之间的差异有统计学意义（P<0.05），其合并效应量为［OR=0.57，95%CI=(0.34，0.93)］。结论:与单纯胸腔化疗相比，联合疗法可提高近期疗效，显著改善患者生活质量，并且临床安全性较好，但其长期疗效和安全性评价尚需大样本高质量的研究进一步验证。

Efficacy and safety of intrathoracic chemotherapy combined with thermotherapy for malignant pleural effusion of lung cancer:A systematic review

Objective:To systematically review the efficacy and safety of intrathoracic chemotherapy combined with thermotherapy (ITCT) for malignant pleural effusion (MPE) of lung cancer.Methods:We searched foreign databases as Cochrane Library，PubMed，EMbase，Web of Science and Chinese ones as CBM，CNKI，VIP and WanFang with computer，and also retrieved other sources as supplying.All relevant randomized controlled trials (RCTs) were collected to compare ITCT and monotherapy of intrathoracic chemotherapy (ITC) or thermotherapy.After literature screening，data extraction and quality evaluation according to the protocal，Meta-analyses were performed using the RevMan 5.3 software.Results:23 RCTs involving 1 329 patients were included.For efficacy assessment，total effective rate，complete remission rate and improving rate of life quality of ITCT group were superior to ITC group，and there were all significant differences (P<0.05).The combined effects were ［OR=3.95，95%CI=(3.04，5.13)］，［OR=2.80，95%CI=(2.13，3.68)］，and ［OR=3.11，95%CI=(2.34，4.14)］，respectively.For safety assessment，the incidence of stethalgia，leukocytopenia，nausea and vomiting，kidney lesion and fever in ITCT group were lower than ITC group.However，only the incidence of stethalgia had significant difference (P<0.05)，and the combined effect was ［OR=0.57，95%CI=(0.34，0.93)］.Conclusion:Compared with ITC，ITCT can significantly improve short-term curative effect and life quality of patients with MPE of lung cancer.Additionally，it is safe and feasible.But its long-term survival rate and security still need to be further verified by more large sample and high quality studies.