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中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (04) : 450 -456. doi: 10.3877/cma.j.issn.1674-6902.2017.03.018

所属专题: 专题评论 文献

论著

一线用药的EGFR抑制剂治疗临床选择型非小细胞肺癌有效性的系统评价
田春琴1,(), 赵新汉2, 耿会生3, 崔立春4, 王旋4, 杜建飞4   
  1. 1. 710061 西安,西安交通大学第一附属医院肿瘤科;710016 西安,国际合作长安医院肿瘤科
    2. 710061 西安,西安交通大学第一附属医院肿瘤科
    3. 710016 西安,国际合作长安医院放疗中心
    4. 710016 西安,国际合作长安医院肿瘤科
  • 收稿日期:2016-06-24 出版日期:2017-08-20
  • 通信作者: 田春琴

System evalution on effectiveness of EGFR-TKIs compared with chemotherapy in treatment of clinical-selected non-small-cell lung carcinoma

Chunqin Tian1,(), Xinhan Zhao2, Huisheng Geng3, Lichun Cui4, Xuan Wang4, Jianfei Du4   

  1. 1. Oncology Department of Xi′an jiaotong university first affiliated hospital, xi an 710061 China; Oncology Department of the International cooperation Chang′an Hospital, Xi′an China 710016
    3. Radiotherapy Centre Department of the International cooperation Chang′an Hospital, xi′an 710016 China
    4. Oncology Department of the International cooperation Chang′an Hospital, Xi′an China 710016
  • Received:2016-06-24 Published:2017-08-20
  • Corresponding author: Chunqin Tian
  • About author:
    Corresponding author: Tian Chunqin, Email:
引用本文:

田春琴, 赵新汉, 耿会生, 崔立春, 王旋, 杜建飞. 一线用药的EGFR抑制剂治疗临床选择型非小细胞肺癌有效性的系统评价[J/OL]. 中华肺部疾病杂志(电子版), 2017, 10(04): 450-456.

Chunqin Tian, Xinhan Zhao, Huisheng Geng, Lichun Cui, Xuan Wang, Jianfei Du. System evalution on effectiveness of EGFR-TKIs compared with chemotherapy in treatment of clinical-selected non-small-cell lung carcinoma[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(04): 450-456.

目的

系统评价并对比表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)与化疗对一线治疗临床选择型NSCLC患者的疗效。

方法

自PubMed、Cochrane library、EMBASE中检索相关的主题词及自由词,收集EGFR-TKIs与化疗相比一线治疗临床选择型NSCLC疗效的随机对照研究文献(randomized controlled trials, RCT)。按纳入标准及排除标准筛选文献,采用cochrane偏倚风险评估表对纳入文献进行质量评价,自纳入文献中提取有效数据,应用RevMan 5.3.5和STATA 12.0分析并对比临床选择型NSCLC患者在EGFR-TKIs治疗中的疗效。采用敏感性分析和发表偏倚分析评价结果的稳定性和可靠性。

结果

共纳入5篇RCT文献,共1 719例患者,Meta分析结果显示:对于临床选择型(亚裔、腺癌、不吸烟)的NSCLC患者:一线EGFR-TKIs(吉非替尼)治疗与化疗相比,总生存期(overall survival, OS)、无进展生存期(progress free survival, PFS)、相对危险度(risk ratio, RR)无明显差异;EGFR-TKIs联合化疗的一线治疗与单纯化疗相比,OS、PFS、RR无明显差异。

结论

对比化疗,选择型NSCLC患者一线EGFR-TKIs治疗无获益。

Objective

To analyze the effectiveness of epithelial growth factor receptor-TKIs(EGFR-TKIs) compared with chemotherapy on the clinical-selected patients.

Method

Randomized controlled trials(RCT) evaluating the effectiveness of EGFR-TKIs compared with chemotherapy as first line treatment of the clinical-selected NSCLC were obtained from PubMed, the Cochrane library and EMBASE. All literatures were assessed by the inclusion and exclusion criteria, quality assessment and data abstraction. The Meta analysis was performed by RevMan 5.3.5 (Cochrane Collaboration) and STATA 12.0 (STATA Corp, College station, TX) software and was contrasted in EGFR TKIs-treatment of the clinical-selected NSCLC patients curative effect. The stability and reliability were evaluated by sensitivity analysis and publication bias analysis.

Results

A total of 5 trials with 1 719 patients were included in the meta-analysis. The RR, PFS and OS of clinical-selected NSCLC patients treated with EGFR-TKIs alone or EGFR-TKIs in combination with chemotherapy as first-line therapy didn′t significantly increased compared with that of the patients treated with chemotherapy.

Conclusion

EGFR-TKIs therapy as first-line treatment was not suit for clinical-selected NSCLC patients.

图1 检索流程
表1 纳入Meta分析的2项研究的基本资料
表2 作为一线用药的EGFR抑制剂对比化疗治疗临床选择型NSCLC患者的方法学偏倚
图2 作为一线用药的EGFR抑制剂对比化疗治疗临床选择型NSCLC患者总体生存期的森林图
表3 作为一线用药的EGFR抑制剂联合化疗对比单纯化疗治疗临床选择型NSCLC患者RCT基线资料
表4 作为一线用药的EGFR抑制剂联合化疗对比单纯化疗治疗临床选择型NSCLC患者RCT的方法学偏倚
图3 作为一线用药的EGFR抑制剂联合化疗对比单纯化疗治疗临床选择型NSCLC患者无进展生存期的森林图
图4 作为一线用药的EGFR抑制剂联合化疗对比单纯化疗治疗临床选择型NSCLC患者总体生存期的森林图
图5 作为一线用药的EGFR抑制剂联合化疗对比单纯化疗治疗临床选择型NSCLC患者客观反应率的森林图
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