【摘要】：目的:應(yīng)用meta分析評(píng)估放療聯(lián)合EGFR-TKIs對(duì)比放療治療非小細(xì)胞肺癌腦轉(zhuǎn)移的療效及安全性。方法:在Pubmed數(shù)據(jù)庫(kù)、Embase數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、中國(guó)知網(wǎng)、萬(wàn)方醫(yī)學(xué)網(wǎng)等數(shù)據(jù)中,使用主題詞加自由詞的檢索策略,檢索出放療聯(lián)合EGFR-TKIs對(duì)比放療治療非小細(xì)胞肺癌腦轉(zhuǎn)移的前瞻性臨床對(duì)照試驗(yàn)。嚴(yán)格按照納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選文獻(xiàn),并使用改良Jadad量表對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià),提取納入文獻(xiàn)中的主要數(shù)據(jù),應(yīng)用Revman5.3軟件及Stata 12.0軟件對(duì)提取數(shù)據(jù)進(jìn)行meta分析,并同時(shí)對(duì)結(jié)果進(jìn)行敏感性分析及發(fā)表偏倚分析。結(jié)果:最終納入7篇文獻(xiàn),其中隨機(jī)對(duì)照臨床試驗(yàn)6篇,非隨機(jī)對(duì)照試驗(yàn)1篇,試驗(yàn)組EGFR-TKIs聯(lián)合放療治療共254例,對(duì)照組單純放療或單純放療聯(lián)合安慰劑治療共245例。Meta分析結(jié)果顯示:EGFR-TKI+RT組對(duì)比RT組,在腫瘤緩解方面,聯(lián)合組的客觀緩解率ORR以及疾病控制率DCR要高于RT組[ORR(RR=1.82,95%CI:[1.47,2.26],P0.00001),DCR(RR=1.30,95%CI:[1.17,1.45],P0.00001)];在腫瘤患者預(yù)后生存方面,聯(lián)合組的1年總生存率以及中位生存期高于RT組,但差異都無(wú)統(tǒng)計(jì)學(xué)意義[1年總生存率(RR=1.69,95%CI:[0.97,2.95],P=0.06),m OS(MSR=1.134,95%CI:[0.653,1.969],P=0.656)];在治療毒副反應(yīng)方面,聯(lián)合組患者發(fā)生皮疹、腹瀉的概率要明顯高于RT組,[Rash(RR=18.06,95%CI:[6.77,48.16],P0.00001),Dirrahoea(RR=3.98,95%CI:[1.99,7.95],P0.0001)]。結(jié)論:在非小細(xì)胞肺癌腦轉(zhuǎn)移的患者中,放療聯(lián)合EGFR-TKI治療患者的客觀緩解率ORR、疾病控制率DCR明顯高于單純放療組,但聯(lián)合組在改善患者的1年總生存率及中位生存期方面并沒(méi)有優(yōu)勢(shì),且聯(lián)合組患者發(fā)生皮疹、腹瀉等毒副作用的概率更高。
[Abstract]:Objective: to evaluate the efficacy and safety of radiotherapy combined with EGFR-TKIs in the treatment of brain metastasis from non-small cell lung cancer (NSCLC) by meta analysis. Methods: in Pubmed database, Embase database, Chinese biomedical literature database, Chinese knowledge website, Wanfang Medical Network and other data, the retrieval strategy of subject words and free words was used. A prospective clinical controlled trial of radiotherapy combined with EGFR-TKIs in the treatment of brain metastasis from non-small cell lung cancer was searched. According to the criteria of inclusion and exclusion, the quality of the documents was evaluated by the modified Jadad scale, the main data were extracted, and the extracted data were analyzed by meta with Revman5.3 software and Stata 12.0 software, and the quality of the data was evaluated by using the modified Revman5.3 scale. At the same time, the results were analyzed by sensitivity analysis and publication bias analysis. Results: seven articles were included, including 6 randomized controlled clinical trials and 1 non-randomized controlled trial. There were 254patients treated with EGFR-TKIs combined with radiotherapy in the trial group. The results of Meta-analysis showed that the EGFR-TKI RT group was better than the RT group in tumor remission, and the results of meta-analysis showed that the patients in the control group were treated with radiotherapy alone or radiotherapy alone combined with placebo. Objective remission rate (ORR) and disease control rate (DCR) in the combined group were higher than those in the RT group [ORR (RR=1.82,95%CI: [1.47, 2.26], P0.00001), DCR (RR=1.30,95%CI: [1.17,1.45], P0.00001); In terms of prognosis and survival, the 1-year overall survival rate and median survival time in the combined group were higher than those in the RT group, but there was no significant difference between the two groups [1-year overall survival rate (RR=1.69,95%CI: [0.97, 2.95], P < 0.05). M OS (MSR=1.134,95%CI: [0.653, 1.969], P = 0.656); In the treatment of toxic side effects, the incidence of diarrhea in the combined group was significantly higher than that in the RT group, [Rash (RR=18.06,95%CI: [6.77,48.16], P0.00001), Dirrahoea (RR=3.98,95%CI: [1.99,7.95], P 0.0001). Conclusion: in patients with brain metastasis from non-small cell lung cancer, the objective remission rate of patients treated with radiotherapy combined with EGFR-TKI was significantly higher than that of patients treated with radiotherapy alone. The rate of ORR, disease control was significantly higher than that of radiotherapy alone. However, the combined group had no advantage in improving the overall 1-year survival rate and the median survival time, and the combined group had a higher probability of side effects such as rash and diarrhoea.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R734.2

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