双药方案对比单药方案治疗老年晚期非小细胞肺癌的Meta分析

背景与目的双药方案治疗老年晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效是否优于单药化疗尚存争议,本研究旨在对双药方案治疗老年晚期NSCLC患者的有效性和安全性进行系统评价。方法计算机检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库和中国生物医学文献等数据库,收集双药方案治疗老年晚期NSCLC的随机对照试验,用Stata11.0软件对数据进行meta分析。结果共纳入12项随机对照试验(2,306例病例),meta分析结果显示与单药化疗相比双药化疗明显提高了老年晚期NSCLC患者的有效率(OR=1.80,95%CI:1.50-2.17,P<0.000,1)和1年生存率(OR=1.45,95%CI:1.22-1.72,P<0.000,1);含铂双药(OR=1.55,95%CI:1.18-2.03,P=0.001)和非铂双药组(OR=1.38,95%CI:1.10-1.73,P=0.006)的1年生存率均明显高于单药组;含铂双药组更易发生3/4级贫血、中性粒细胞减少、血小板减少和神经毒性(P<0.05),非铂双药组毒副反应发生率与单药组相似。结论与单药组相比,双药组可明显提高化疗有效率和生存率,更适合作为老年晚期NSCLC一线化疗方案,但尚需开展针对老年患者的随机对照试验加以验证。

A Meta Analysis of Doublets Versus Single-agent Chemotherapy for Elderly Patients with Advanced Non-small Cell Lung Cancer

Background and objective It remains disputed whether doublets are more effective than single-agent chemotherapy for elderly patients with advanced non-small cell lung cancer(NSCLC).The aim of this study is to evaluate the efficacy and safety of doublets and single-agent chemotherapy for elderly patients with NSCLC.Methods Data from all published,randomized trials that compared doublets and single-agent chemotherapy in elderly patients were collected from electronic databases(PubMed,EMBASE,Cochrane Library,CNKI and the CBMdice).Meta-analysis was completed using software Stata 11.0.Results The results of the meta-analysis,including 12 eligible trials(2,306 patients),showed that the doublets significantly increased the overall response rate(OR=1.80,95%CI:1.50-2.17,P<0.000,1) and one-year survival rate(OR=1.45,95%CI:1.22-1.72,P<0.000,1) compared with single-agent chemotherapy.The results of one-year survival rate in platinum-based doublet chemotherapy arms(OR=1.55,95%CI:1.18-2.03,P=0.001) and non platinum-based ones(OR=1.38,95%CI:1.10-1.73,P=0.006) were both significantly higher than that of single-agent chemotherapy.However,grade 3/4 anemia,neutropenia,thrombocytopenia and neurotoxicity(P<0.05) were significantly associated with doublet chemotherapy.The incidence of toxicity effect in non platinum-based chemotherapy was similar to that of single-agent chemotherapy.Conclusion Compared with single-agent chemotherapy,doublet chemotherapy could increase the overall response rate and oneyear survival rate significantly.Therefore,doublet chemotherapy would be more appropriate for elderly patients with advanced NSCLC as the first-line chemotherapy regimen.However,further prospective randomized controlled trials in elderly NSCLC patients is needed to verify the findings in this study.