顺铂联合吉西他滨支气管动脉灌注治疗非小细胞肺癌的Meta分析

目的:系统评价顺铂联合吉西他滨支气管动脉灌注用于非小细胞肺癌(NSCLC)的有效性与安全性。方法:计算机检索PubMed、EMbase、The Cochrane Library、CNKI、CBM、VIP及万方数据库,收集顺铂联合吉西他滨支气管动脉灌注用于晚期NSCLC的临床对照研究,检索时限为建库至2017年6月。由2名研究者按照入选标准严格筛选文献、提取数据并对文献质量进行评估后,采用RevMan 5.3软件进行Meta分析。结果:纳入研究11篇,患者761名。Meta分析结果显示支气管动脉化疗有效率RR=1.65,95%CI(1.40,1.94),P<0.000 01]、临床获益率RR=1.14,95%CI(1.07,1.21),P<0.000 1]、1年期生存率RR=1.41,95%CI(1.06,1.90),P=0.02]优于静脉化疗;不良反应中血小板下降和胃肠道反应发生率优于对照组(P=0.03及0.003),其余(白细胞下降、血红蛋白下降及肝肾功异常)无差异。结论:支气管动脉灌注顺铂联合吉西他滨化疗对晚期NSCLC患者的近期疗效优于静脉化疗,且不良反应发生率近似,但总体证据质量中等,仍需高质量研究提供临床证据。

Intra-arterial infusion of cisplatin combined with gemcitabine for patient with non-small cell lung cancer: a Meta analysis

OBJECTIVE To access the safety and efficacy of cisplatin combined with gemcitabine for patient with non-small cell lung cancer by bronchial artery infusion.METHODS PubMed,EMbase,The Cochrane Library,CNKI,CBM,VIP and WanFang Data were searched from inception to June 2017.Clinical control trails on arterial infusion of cisplatin combined with gemcitabine in patient with non-small cell lung cancer were collected.Two reviewers independently screened literatures,extracted data and assessed the risk of bias of the included studies,and meta analysis was performed by using RevMan 5.3.RESULTS Eleven studies involving 761 patients were included.Meta analysis results suggested that intra-arterial chemotherapy was superior to intravenous chemotherapy in response rateRR=1.65,95%CI (1.40,1.94),P<0.000 01],clinical benefit rateRR=1.14,95%CI (1.07,1.21),P<0.000 1] and 1-year survival rateRR=1.41,95%CI (1.06,1.90),P=0.02].Bronchial artery infusion was associated with lower incidence rates of thrombocytopenia and gastrointestinal reactions (P=0.03 and 0.003),but there was no significant difference in leukopenia,reduced hemoglobin or influence on hepatorenal function.CONCLUSION Intra-arterial chemotherapy by using cisplatin combined with gemcitabine for patients with advanced non-small cell lung cancer is effective,with similar safety to intravenous chemotherapy.However,the quality of evidence is moderate,and further high quality study is needed.