中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

新辅助化疗应用于 Ⅲa 期非小细胞肺癌的系统评价与 Meta 分析

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目的 对新辅助化疗联合外科手术治疗 Ⅲa 期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者带来的收益性及疗效进行 Meta 分析。 方法 计算机检索 WangFang Data、Web of Science、PubMed、EMbase、CNKI、The Cochrane Library、VIP、CBM 等数据库,对新辅助化疗治疗 Ⅲa 期 NSCLC 患者的随机对照试验(RCT)进行搜索,检索时限从建库至 2017 年 10 月。采用 Jadad 评分法进行文献质量评价,采用 RevMan 5.3 版本的软件进行 Meta 分析。 结果 总共纳入 15 个随机对照实验的文章,共 1 899 例 NSCLC 患者。Meta 分析结果显示:新辅助化疗组的手术 R0 切除率跟对照组(未行新辅助化疗组)相比,要明显高[OR=2.04,95%CI(1.52,2.74),P<0.05],但是两组患者在术后并发症方面却并没有明显的统计学差异[OR=1.23,95%CI(0.89,1.69),P=0.22];在生存率方面,新辅助化疗在患者的 1 年[OR=1.38,95%CI(1.01,1.88),P=0.04]、3 年[OR=1.57,95%CI(1.16,2.12),P=0.004]、5 年生存率[OR=2.09,95%CI(1.24,3.53),P=0.005]显著提高。 结论 与对照组相比,新辅助化疗联合外科手术在 Ⅲa 期 NSCLC 患者的手术 R0 切除率和患者的 1 年、3 年、5 年生存率方面,能够有所改善,且不增加患者的术后并发症。因纳入研究的文章在质量等级和数量方面可能有所欠缺,所以本次研究的结果仍需开展更高质量的研究予以验证其准确性。

Objective To systematically evaluate the profitability and efficacy of neoadjuvant chemotherapy in patients with stage Ⅲa non-small cell lung cancer. Methods Randomized controlled trials (RCT) on neoadjuvant chemotherapy for stage Ⅲa non-small cell lung cancer were collected from WangFang Data database, Web of Science, PubMed, EMbase, CNKI, The Cochrane Library, VIP and CBM databases. From building to October 2017. After two independent reviewers screened the literature, extracted data and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results A total of 15 RCT were included, including 1899 non-small cell lung cancer patients. The results of Meta analysis showed that the resection rate of R0 in neoadjuvant chemotherapy group was significantly higher than that in control group (OR=2.04, 95%CI 1.52 to 2.74, P<0.05), and there was no significant difference in postoperative complications between two groups (OR=1.23, 95%CI 0.89 to 1.69, P=0.22). In terms of survival rate, the neoadjuvant chemotherapy group could improve patients for one year (OR=1.38, 95%CI 1.01 to 1.88, P=0.04), three years (OR=1.57, 95%CI 1.16 to 2.12, P=0.004) and 5 years survival rate (OR=2.09, 95%CI 1.24 to 3.53, P=0.005) significance of learning. Conclusion Compared with the control group, neoadjuvant chemotherapy can improve the surgical R0 resection rate and the one, three and five year survival rate of patients with stage Ⅲa non-small cell lung cancer without increasing the postoperative complications. Due to the quantity and quality limitations of the included studies, the above conclusion still needs to be verified by more high-quality research.

关键词: 新辅助; Ⅲa 期; 非小细胞肺癌; Meta 分析

Key words: Neoadjuvant; stage IIIa; non-small cell lung cancer; meta-analysis

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