顺铂合伊立替康或依托泊苷治疗广泛期小细胞肺癌Meta分析
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摘要
目的:评价顺铂联合IP与顺铂联合EP治疗广泛期小细胞肺癌的临床疗效及安全性。方法:计算机检索Pubmed、Medline、中国知网(CNKI)、维普网(VIP)及万方数据知识服务平台等数据库,筛选关于顺铂联合伊立替康与顺铂联合依托泊苷治疗广泛期小细胞肺癌的相关文献,检索时间为建库～2018年8月。采用Rev Man5.3.0软件对文献数据进行Meta分析。结果:最终纳入8篇中文文献,包括488例患者,IP组与EP组临床有效率(RR)(OR=1.06,95%CI:0.93～1.21,P=0.41)、疾病控制率(DCR)(OR=1.02,95%CI:0.91～1.13,P=0.77)比较,差异无统计学意义。在安全性方面,IP主要表现为消化道毒性(OR=3.80,95%CI:2.39～6.02,P<0.000 01),EP主要表现为血液毒性,特别是中性粒细胞减少(OR=0.26,95%CI:0.15～0.42,P=0.000 01)。结论 :IP方案的疗效与EP方案相似,对小细胞癌有较好的临床应用价值。IP方案毒性主要表现在消化系统,EP方案毒性主要表现在骨髓抑制。
Objective: To assess the efficacy and safety of cisplatin combined with IP or EP in patients with extensive-disease small cell lung cancer. Methods: The Pubmed, Medline, CNKI, VIP and Wanfang data were searched to collect the literature on cisplatin combined with irinotecan or etoposide in the treatment of extensive-disease small cell lung cancer, from creating database to August 2018.The Rev Man 5.3.0 software was used for meta-analysis. Results: There was no significant difference in clinical efficacy(RR)(OR=1.06,95%CI: 0.93～1.21, P=0.41), disease control rate(DCR)(OR=1.02, 95%CI: 0.91～1.13, P=0.77) between IP group and EP group. In safety,there was mainly gastrointestinal toxicity(OR=3.80, 95%CI: 2.39～6.02, P<0.000 01) in IP group. And mainly hematotoxicity, especially neutropenia(OR=0.45, 95% CI: 0.29～0.70, P=0.000 4) in EP group. Conclusion: The efficacy of IP chemotherapy is similar to EP chemotherapy, and it has better clinical application value for small cell lung cancer. The toxicity of IP chemotherapy is mainly manifested in the digestive system, while the toxicity of EP chemotherapy is mainly manifested in bone marrow suppression.
Objective: To assess the efficacy and safety of cisplatin combined with IP or EP in patients with extensive-disease small cell lung cancer. Methods: The Pubmed, Medline, CNKI, VIP and Wanfang data were searched to collect the literature on cisplatin combined with irinotecan or etoposide in the treatment of extensive-disease small cell lung cancer, from creating database to August 2018.The Rev Man 5.3.0 software was used for meta-analysis. Results: There was no significant difference in clinical efficacy(RR)(OR=1.06,95%CI: 0.93～1.21, P=0.41), disease control rate(DCR)(OR=1.02, 95%CI: 0.91～1.13, P=0.77) between IP group and EP group. In safety,there was mainly gastrointestinal toxicity(OR=3.80, 95%CI: 2.39～6.02, P<0.000 01) in IP group. And mainly hematotoxicity, especially neutropenia(OR=0.45, 95% CI: 0.29～0.70, P=0.000 4) in EP group. Conclusion: The efficacy of IP chemotherapy is similar to EP chemotherapy, and it has better clinical application value for small cell lung cancer. The toxicity of IP chemotherapy is mainly manifested in the digestive system, while the toxicity of EP chemotherapy is mainly manifested in bone marrow suppression.
引文
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[17]王琪,胡伟国,宋启斌.铂类联合伊立替康与铂类联合依托泊苷一线治疗广泛期小细胞肺癌的系统评价研究[J].肿瘤学杂志,2015,21(8):623-632
[18]Sasse Sr EC,Lima JP,Santos LV,et al.Irinotecan plus platinum analog(IP)compared to etoposide plus platinum analog(EP)in extensive stage small cell lung cancer(ED-SCLC):Systematic review with meta-analysis[J].J Clin Oncol,2009,27(Suppl):8105
[2]Yu Yang Soon,Huili Zheng,Shaun Zhirui Ho,et al.Adoption of prophylactic cranial irradiation(PCI)for extensive stage small cell lung cancer(ES-SCLC):a population based outcome study[J].Radiat Oncol,2018,13(1):247
[3]卢平.伊立替康或依托泊苷联合顺铂治疗广泛期小细胞肺癌的疗效观察[J].河南医学研究,2015,24(9):55-56
[4]曾筱怡.IP和EP两种方案治疗广泛期小细胞癌疗效观察及安全性分析[J].当代医学,2016,22(10):151-152
[5]张容榕,林琳,刘爱学,等.两种方案治疗广泛期小细胞肺癌的临床观察[J].肿瘤预防与治疗,2014,27(3):130-133
[6]严鹏,陈元.伊立替康联合顺铂方案对照依托泊甙联合顺铂方案治疗广泛期小细胞肺癌疗效的回顾性分析[J].中国血液流变学杂志,2011,21(4):656-657
[7]唐维,陈坚贤,黄广优,等.伊立替康联合顺铂方案与依托泊甙联合顺铂方案治疗广泛期小细胞肺癌疗效对比分析[J].医药前沿,2017,7(33):23-24
[8]王慧娟,闫相涛,路平,等.伊立替康联合顺铂与依托泊苷联合顺铂方案一线治疗广泛期小细胞肺癌的多中心临床研究结果[J].中国癌症杂志,2011,21(10):783-788
[9]郭爱萍,余宗阳,欧阳学农.伊立替康联合顺铂与依托泊苷联合顺铂方案一线治疗广泛期小细胞肺癌的临床疗效观察[J].现代肿瘤医学,2014,22(12):2889-2891
[10]汪晓洁,李丽华,寿涛,等.IP与EP方案治疗广泛期小细胞肺癌的临床疗效比较[J].实用医学杂志,2012,28(17):2946-2947
[11]Yan H,Xin S,Ma J,et al.A three microRNA‐based prognostic signature for smal lcell lung cancer overall survival[J].J Cell Biochem,2018,doi:10.1002/jcb.28159
[12]Oze I,Hotta K,K Kiura,et al.Twenty-Seven Years of PhaseⅢTrials for Patients with Extensive Disease Small-Cell Lung Cancer:Disappointing Results[J].PLoS One,2009,4(11):e7835
[13]Lima JP,Sasse AD,Sasse EC,et al.Outcomes of North American,Japanese,andEuropean extensive-disease small cell lung cancer(ED-SCLC)patients under irinotecan-platinum or etoposide-platinum therapy:Systematic review and meta-analysis[J].Physics of Plasmas,2013,20(12):240
[14]Hu Q,Wang Q,Zhu H,et al.Irinotecan compared with etoposide in combination with platinum in previously untreated extensive stage small cell lung cancer:An updated systemic review[J].J Cancer Res Ther,2016,12(2):881-887
[15]Hanna N,Bunn PA Jr,Langer C,et al.Randomized phaseⅢtrial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer[J].J Clin Oncol,2006,24(13):2038-2043
[16]Zatloukal P,Cardenal F,Szczesna A,et al.A multicenter international randomized phaseⅢstudy comparing cisplatin in combination with irinotecan or etoposide in previously untreated small-cell lung cancer patients with extensive disease[J].Ann Oncol,2010,21(9):1810-1816
[17]王琪,胡伟国,宋启斌.铂类联合伊立替康与铂类联合依托泊苷一线治疗广泛期小细胞肺癌的系统评价研究[J].肿瘤学杂志,2015,21(8):623-632
[18]Sasse Sr EC,Lima JP,Santos LV,et al.Irinotecan plus platinum analog(IP)compared to etoposide plus platinum analog(EP)in extensive stage small cell lung cancer(ED-SCLC):Systematic review with meta-analysis[J].J Clin Oncol,2009,27(Suppl):8105