【摘要】：目的：系統(tǒng)評(píng)價(jià)聯(lián)合鉑類(lèi)的雙藥方案和非鉑類(lèi)單藥方案二線治療晚期非小細(xì)胞肺癌(NSCLC, non-small-cell lung cancer)患者的有效性及安全性。方法：計(jì)算機(jī)檢索PubMed、The Cochrane Library、Web of science、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、相關(guān)期刊論文(CNKI)和萬(wàn)方數(shù)據(jù)庫(kù),收集含鉑雙藥化療方案對(duì)比非鉑單藥化療方案二線治療晚期NSCLC的隨機(jī)對(duì)照試驗(yàn),用RevMan5.2進(jìn)行薈萃分析。結(jié)果：最終納入11項(xiàng)臨床隨機(jī)對(duì)照試驗(yàn),共1167例患者。Meta分析結(jié)果顯示與非鉑單藥方案相比,含鉑雙藥方案化療可提高晚期NSCLC患者的化療客觀有效率(ORR)及疾病控制率(DCR),分別為1.43倍(RR=1.43,95%CI:1.08～1.89, P=0.010)和1.16倍(RR=1.16,95%CI:1.05～1.27, P=0.002)。同時(shí),含鉑雙藥方案化療亦可延長(zhǎng)晚期NSCLC患者的無(wú)進(jìn)展生存期(PFS, progression-free survival) (HR=0.74,95%CI:0.58～0.95, P=0.020),但含鉑雙藥化療與非鉑單藥化療兩組1年生存率差異無(wú)統(tǒng)計(jì)學(xué)意義(RR=1.21,95%CI:0.91～1.61, P=0.190)。安全性方面,含鉑雙藥方案化療最主要的不良反應(yīng)為血小板減少(RR=2.99,95%CI:1.95～4.59, P0.001)；而3/4級(jí)白細(xì)胞減少、中性粒細(xì)胞減少、惡心嘔吐、貧血等不良反應(yīng),含鉑雙藥化療組與非鉑單藥化療組兩組差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：與非鉑單藥化療方案相比,含鉑雙藥方案可提高晚期NSCLC患者化療客觀有效率及疾病控制率,延長(zhǎng)晚期NSCLC患者的無(wú)進(jìn)展生存期,但不能明顯改善1年生存率。最主要不良反應(yīng)為血小板減少,低毒耐受性好。因此,含鉑雙藥化療方案在一線治療失敗的晚期NSCLC患者的二線治療中值得進(jìn)一步推廣。
[Abstract]:Objective: to evaluate the efficacy and safety of two-line chemotherapy combined with platinum regimen and non-platinum regimen in patients with advanced non-small cell lung cancer (NSCLC, non-small-cell lung cancer). Methods: PubMed,The Cochrane Library,Web of science, Chinese biomedical literature database (CBM), Chinese periodical full-text database (CNKI) and Wanfang database were searched by computer. A randomized controlled trial of two-line chemotherapy regimen containing platinum and two-line non-platinum chemotherapy regimen for advanced NSCLC was collected. RevMan5.2 was used for meta-analysis. Results: a total of 1167 patients were enrolled in 11 randomized controlled trials. The results of Meta analysis were compared with those of non-platinum monotherapy regimen. Dual regimen chemotherapy with platinum can improve the objective effective rate of chemotherapy, (ORR) and disease control rate (DCR), of patients with advanced NSCLC 1.43 times (RR=1.43,95%CI:1.08~1.89,) P0. 010 and 1. 16 times (RR=1.16,95%CI:1.05~1.27, P0. 002). At the same time, combination chemotherapy with platinum could also prolong the progression free survival (PFS, progression-free survival) (HR=0.74,95%CI:0.58~0.95, P0. 020) in patients with advanced NSCLC. However, there was no significant difference in 1-year survival rate between the two groups (RR=1.21,95%CI:0.91~1.61, P0. 190). In terms of safety, thrombocytopenia (RR=2.99,95%CI:1.95~4.59, P0.001) was the main adverse effect of chemotherapy with platinum. However, there were no significant differences in adverse reactions such as 3 / 4 grade leukopenia, neutropenia, nausea, vomiting and anemia between the two groups. Conclusion: compared with non-platinum single-drug chemotherapy regimen, the chemotherapy regimen containing platinum can improve the objective effective rate and disease control rate of patients with advanced NSCLC, prolong the progression-free survival time of patients with advanced NSCLC, but can not obviously improve the 1-year survival rate. The main adverse effects were thrombocytopenia and low toxicity tolerance. Therefore, platinum-containing dual-drug chemotherapy regimen is worthy of further promotion in the second-line treatment of patients with advanced NSCLC who fail in first line treatment.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R734.2
，

本文編號(hào)：2334245