【摘要】：目的:目前,吉非替尼、厄洛替尼及�？颂婺嶂委煼切〖�(xì)胞肺癌的臨床療效尚存在一定爭(zhēng)議,本研究通過網(wǎng)絡(luò)meta分析比較三種藥物治療非小細(xì)胞肺癌的臨床療效及安全性,為非小細(xì)胞肺癌的臨床藥物應(yīng)用提供一定的參考依據(jù)。方法:兩名研究者對(duì)Cochrane、PubMed、EMbase、Sciencedirect、CNKI、萬方和維普等數(shù)據(jù)庫(kù)獨(dú)立地檢索文獻(xiàn),并進(jìn)行文獻(xiàn)篩選、提取資料和交叉核對(duì)。結(jié)局指標(biāo)包括完全緩解(CR)、部分緩解(PR)、疾病穩(wěn)定(SD)、疾病進(jìn)展(PD)、總有效率(ORR)、疾病控制率(DCR)、無進(jìn)展生存期(PFS)、中位生存時(shí)間(MST)、不良反應(yīng)等。其中不良反應(yīng)包括皮疹、腹瀉、惡心嘔吐、肝功異常及乏力。納入研究的結(jié)果采用Rev Man 5.2軟件、R3.3.0軟件及Stata 13.0軟件進(jìn)行結(jié)果分析。結(jié)果:共納入43篇文獻(xiàn),7168例患者。網(wǎng)絡(luò)meta分析發(fā)現(xiàn),CR、PR、SD、PD、ORR及DCR未見統(tǒng)計(jì)學(xué)差異;對(duì)于不良反應(yīng),厄洛替尼發(fā)生惡心嘔吐為吉非替尼的2.0倍(95%Cr I:1.1-3.7),而皮疹、腹瀉、肝功異常及乏力未見統(tǒng)計(jì)學(xué)差異。藥物之間兩兩比較的meta分析發(fā)現(xiàn),吉非替尼的SD為厄洛替尼的0.86倍(95%CI:0.75-0.99,P=0.04);吉非替尼引起皮疹的風(fēng)險(xiǎn)為厄洛替尼的0.45倍(95%CI:0.36 0.55,P0.05),是�？颂婺岬�1.57倍(95%CI:1.18 2.09,P=0.002);吉非替尼引起腹瀉的風(fēng)險(xiǎn)為厄洛替尼的0.75倍(95%CI:0.61 0.92,P=0.005);吉非替尼引起的惡心嘔吐為厄洛替尼的0.47倍(95%CI:0.27-0.84,P=0.01);吉非替尼引起乏力的風(fēng)險(xiǎn)為厄洛替尼的0.43倍(95%CI:0.24-0.76,P=0.004)。吉非替尼、厄洛替尼和埃克替尼的PFS分別為5.48個(gè)月、5.15個(gè)月、5.81個(gè)月,吉非替尼和�？颂婺峋哂诙蚵逄婺�(P0.05);其MST分別為13.26個(gè)月、13.52個(gè)月、12.58個(gè)月,厄洛替尼分別高于吉非替尼及埃克替尼(P0.05)。結(jié)論:吉非替尼、厄洛替尼及�？颂婺嶂委煼切〖�(xì)胞肺癌患者的臨床療效差異不明顯,但吉非替尼引起惡心嘔吐及乏力的發(fā)生率較低;厄洛替尼治療可以取得較長(zhǎng)的中位生存時(shí)間,但皮疹、腹瀉及惡心嘔吐的發(fā)生率相對(duì)較高;�？颂婺岚l(fā)生皮疹和腹瀉較低,臨床上可根據(jù)患者的具體情況選擇藥物治療。
[Abstract]:Objective: at present, the clinical efficacy of gefitinib, erlotinib and ectini in the treatment of non-small cell lung cancer (NSCLC) is still controversial. This study compared the clinical efficacy and safety of three drugs in the treatment of NSCLC by network meta analysis. To provide a certain reference for the clinical application of non-small cell lung cancer. Methods: two researchers searched independently the databases such as Cochranein PubMeden EMbase Science Direction CNKI, Wanfang and Weip, and carried out literature screening, extracting data and cross-checking. Outcome indicators included complete remission of (CR), partial remission of (PR), stable progression of (SD), disease progression (PD), total effective (ORR), disease control rate (DCR), progression free survival (PFS), median survival time (MST), adverse reactions and so on. Adverse reactions include rash, diarrhea, nausea and vomiting, liver dysfunction and fatigue. The results were analyzed by Rev Man 5.2 software R3.3.0 and Stata 13.0 software. Results: a total of 7168 patients were included in 43 articles. Network meta analysis showed that there was no significant difference in DCR and DCR, but there was no statistical difference in the incidence of nausea and vomiting of erlotinib (95%Cr I: 1.1-3.7), but in rash, diarrhea, abnormal liver function and asthenia. Meta analysis of pairwise comparisons between drugs found that, The SD of gefitinib was 0.86 times that of erlotinib (95CI: 0.75-0.99P0.04), the risk of rashes caused by gefitinib was 0.45 times that of erlotinib (95%CI:0.36 0.55P 0.05), and that of 95%CI:1.18 2.09P0.002; the risk of diarrhea caused by gefitinib was 0.75 times that of erlotinib (95%CI:0.61 0.92P 0.005); and that of gefitinib was 0.75 times that of erlotinib (95%CI:0.61 0.92P0.005). The risk of nausea and vomiting was 0.47 times higher than that of erlotinib (95 CI: 0.27-0.84P0. 01), and the risk of fatigue caused by gifetini was 0.43 times that of erlotinib (95 CI: 0.24-0.76P0. 004). The PFS of gefitinib, erlotinib and ectini were 5.48 months, 5.15 months and 5.81 months, respectively. The MST of gefitinib and Ectini were higher than that of erlotinib (P0.05), their MST were 13.26 months, 13.52 months, 12.58 months, respectively. Erlotinib was higher than gefitinib and Ectini (P0.05). Conclusion: there is no significant difference in the clinical efficacy of gefitinib, erlotinib and ectini in the treatment of non-small cell lung cancer, but the incidence of nausea, vomiting and fatigue caused by gefitinib is lower. The median survival time of erlotinib treatment was longer, but the incidence of rash, diarrhea, nausea and vomiting was relatively high, and the incidence of ectinib rash and diarrhea was lower, and the drug therapy could be selected according to the specific conditions of the patients.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2

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