本文選題：非小細(xì)胞肺癌 + EGFR野生型�。� 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對目前EGFR野生型及EGFR未知突變狀態(tài)的非小細(xì)胞肺癌的后續(xù)治療(即二、三線治療)進(jìn)行網(wǎng)絡(luò)meta分析。方法:制定檢索策略,通過檢索數(shù)據(jù)庫如MEDLINE(1966-2015.11)、EMBASE(1980-2015.11)、Web of Science(1990-2015)、CENTRAL(-2015.11)、google學(xué)術(shù)及clinicaltrial.gov等,同時(shí)補(bǔ)充其他檢索方式,例如檢索相關(guān)文獻(xiàn)的參考文獻(xiàn),最終獲取所有有關(guān)表皮生長因子受體(epidermal growth factor receptor,EGFR)野生型及EGFR未知突變狀態(tài)(即未進(jìn)行EGFR突變檢測)的非小細(xì)胞肺癌后續(xù)治療的隨機(jī)對照試驗(yàn)研究,導(dǎo)入檢索文獻(xiàn),并通過初篩、全文篩選,納入符合要求的文獻(xiàn)全文,對納入研究的基本信息、研究對象特征、干預(yù)措施、結(jié)局指標(biāo)等進(jìn)行綜合、分類,制定研究特征表,采用cochrane偏倚風(fēng)險(xiǎn)評價(jià)工具對研究進(jìn)行偏倚風(fēng)險(xiǎn)評價(jià),用Revman軟件制作偏倚風(fēng)險(xiǎn)評估詳細(xì)表格及總結(jié)圖,用Fast Stone、Adobe Photoshop、Enguage Digital 4.1等軟件提取數(shù)據(jù),運(yùn)用WinBugs、STATA等軟件進(jìn)行網(wǎng)絡(luò)meta分析,制作網(wǎng)絡(luò)圖、網(wǎng)絡(luò)meta結(jié)果表格,并對網(wǎng)絡(luò)meta分析進(jìn)行不一致性和相似性比較,結(jié)果采用總存活數(shù)(overall survival,OS)、無進(jìn)展生存時(shí)間(Progress Free Survival,PFS)作為研究結(jié)局。結(jié)果:共檢索到12501篇文章,其中符合本研究納入標(biāo)準(zhǔn)的文章為21篇,總共9335位受試者,納入研究的藥物包括多西他賽、培美曲賽、厄洛替尼、吉非替尼、雷莫蘆單抗、尼魯單抗、安慰劑、最佳支持治療。在總存活數(shù)方面,有2篇研究分配到尼魯單抗組,11篇研究分配到多西他賽組,8篇研究分配到吉非替尼組,8篇研究分配到培美曲賽組,8篇研究分配到厄洛替尼組,4篇研究分配到安慰劑組,1篇研究分配到雷莫蘆單抗組。網(wǎng)絡(luò)meta分析結(jié)果顯示:與對照組(安慰劑或最佳支持治療)相比,單藥尼魯單抗組(nivolumab)(hr0.56,cri0.42-0.74)、多西他賽組(docetaxel)(hr0.83,cri0.7-0.99)、厄洛替尼組(erlotinib)(hr0.76,cri0.63-0.91)增高了總存活數(shù),并且,將尼魯單抗組與多西他賽組(hr0.67,cri0.54-0.83)、厄洛替尼組(hr0.74,cri0.56-0.97)、吉非替尼組(gefitinib)(hr0.69,cri0.54-0.89)、培美曲賽組(pemetrexed)(hr0.70,cri0.54-0.92)、雷莫蘆單抗(ramucirumab)組(hr0.65,cri0.45-0.92)比較,尼魯單抗組的總存活數(shù)更高。而在無進(jìn)展生存時(shí)間中,網(wǎng)絡(luò)meta分析未發(fā)現(xiàn)明顯統(tǒng)計(jì)學(xué)意義。結(jié)論:在egfr野生型或未知egfr突變狀態(tài)的非小細(xì)胞肺癌后續(xù)治療中,在總存活數(shù)方面,與對照組相比,單藥尼魯單抗、多西他賽、厄洛替尼增高了總存活數(shù);并且,單藥尼魯單抗在提高總存活數(shù)上優(yōu)于多西他賽、培美曲賽、厄洛替尼、吉非替尼、雷莫蘆單抗等藥物。而其他單藥的相互比較(如:多西他賽組vs厄洛替尼組;培美曲賽組vs厄洛替尼組;多西他賽組vs培美曲賽組)在總存活數(shù)及無進(jìn)展生存時(shí)間上均無明顯差異。
[Abstract]:Objective: to analyze the status of EGFR wild-type and EGFR unknown mutation in non-small cell lung cancer (NSCLC) by network meta analysis. Methods: a search strategy was drawn up through searching databases such as MEDLINE (1966-2015.11) and Web of Science (1980-2015). Meanwhile, other retrieval methods, such as references to relevant literature, were supplemented by Google academic and clinicaltrial.gov. Finally, all randomized controlled trial studies on the wild type of epidermal growth factor receptor (EGFR) and the unknown mutation status of EGFR (that is, no EGFR mutation detection) were obtained. Full text screening, including the full text of the documents that meet the requirements, the synthesis, classification, and development of research feature tables of the basic information, the characteristics of the research objects, the intervention measures, the outcome indicators, etc. Cochrane bias risk assessment tool was used to evaluate the bias risk of the study. The detailed form and summary chart of bias risk assessment were made with Revman software. The data were extracted by Fast Stonehmmer Photoshop Digital 4.1, and the network meta analysis was carried out by using WinBugsStella STATA and other software. The network diagram, network meta result table, and the inconsistency and similarity of network meta analysis were compared. The results were as follows: the total survival number was overall survival Free, and no progress survival time was used as the result of the study. Results: a total of 12501 articles were retrieved, of which 21 were eligible for inclusion in this study, and a total of 9335 subjects were included in the study. The drugs included in the study included docetaxel, pemetrexide, erlotinib, gefitinib, remolumab. Neilumab, placebo, best support treatment. In terms of total survival, Two studies were assigned to the Neurumab group 11 studies were assigned to the docetaxel group 8 studies to the gefitinib group eight studies to the pemetrel group eight studies to the erlotinib group and four studies to consolation One study was assigned to the laminumab group. The results of network meta analysis showed that compared with the control group (placebo or best support therapy), Nilumab group increased the total number of survivors, and the docetaxellosil group (docetaxellosil 0.83 cri0.7-0.99), the erlotinib 0.76hr0.66cri3-0.91 group increased the total number of survivors, and, in the docetaxellosil group, the total number of survivors was increased, and the total number of survivors in the single drug Nilumab group was higher than that in the control group (placebo or the best supportive therapy), and there was no significant difference between the two groups. The total survival number of niluximab group was higher than that of doxitaxel group (0.54-0.83), erlotinib group (0.56-0.97), gefitinibtib group (0.54-0.89), pemetrexedhr0.70 cri0.54-0.92( nilumab group). The total survival number of nilumab group was higher than that of pemetrexedhr0.70 cri0.54-0.92 group (P < 0.05). However, no significant statistical significance was found in network meta analysis in the absence of progressive survival time. Conclusion: in the follow-up treatment of non-small cell lung cancer with egfr wild type or unknown egfr mutation status, the total survival rate was increased by single drug Nilumab, docetaxel and erlotinib in comparison with the control group. Neilumab was superior to docetaxel, pemetrexide, erlotinib, gefitinib and remolumab in improving total survival. There was no significant difference in the total survival rate and the survival time without progress between the two groups (e. G. Docetaxel vs erlotinib; pemetrexide vs erlotinib; docetaxel vs pemetrel).
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 戴宏宇;徐玲;夏春偉;陳文萍;;吉非替尼對比培美曲塞二線治療晚期非鱗型非小細(xì)胞肺癌的隨機(jī)對照臨床研究[J];中國肺癌雜志;2013年08期

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本文編號：1906496