新辅助化疗对非小细胞肺癌患者术后生存影响的Meta分析

目的用Meta分析的方法对国内外已发表的高质量的、有关比较新辅助化疗后手术或直接手术对非小细胞肺癌患者术后生存影响的临床随机对照试验进行综合定量分析,为非小细胞肺癌治疗模式的选择提供参考依据。方法收集至2007年7月已公开发表的有关比较新辅助化疗后手术和直接手术对非小细胞肺癌患者术后生存影响的前瞻性随机对照试验,入选的研究利用Revman4.2进行Meta分析。结果符合纳入标准的共10篇文献,总样本量2 546例。其中新辅助化疗组1 291例,直接手术组1 255例;合并相对危险度(relative risk,RR)=0.91,95%可信区间是(0.86~0.96),P为0.000 7。对Ⅲ期非小细胞肺癌进行分层分析,合并RR为0.90,95%可信区间为0.85~0.96,P为0.000 7。结论本研究结果倾向新辅助化疗后手术治疗方案较直接手术方案能提高非小细胞肺癌患者长期生存率,具有统计学意义,但不能因此定论新辅助化疗能提高非小细胞肺癌患者的长期生存率,有必要在今后的研究中开展以包含第3代化疗药的联合化疗方案作为新辅助化疗的高质量的随机对照试验。

Meta-analysis of literature: neoadjnvant chemotherapy versus direct surgery in non-small cell lung cancer

Objective The patients with resectable non-small-cell lung cancer(NSCLC) have a low survival rate following standard surgical treatment.The effectiveness of neoadjuvant chemotherapy on the prognosis of the patients is still controversial.We performed a meta-analysis to evaluate the efficiency of neoadjuvant chemotherapy on the prognosis of the patients in non-small cell lung cancer.Methods Randomized studies published in English and Chinese until 2007 were included in our study.Ten eligible randomized controlled trails including 2 546 patients,were combined and used in the present meta-analysis(1 291 in the study group,1 255 in the control group).Relative risk was calculated from the reports of the studies available and then combined together to get estimate of efficacy.Results Neoadjuvant chemotherapy improved survival with a relative risk of 0.91(95% confidence interval,0.86-0.96;P=0.000 7).Conclusion Our meta-analysis shows a benefit of neoadjuvant chemotherapy to the patients with resectable NSCLC.However,higher quality of trials is still needed,especially with neoadjuvant chemotherapy based on platinum/3rd generation medicine.