热学疗法联合放化疗治疗中晚期非小细胞肺癌的系统评价

发布时间：2018-01-16 04:04

本文关键词：热学疗法联合放化疗治疗中晚期非小细胞肺癌的系统评价　出处：《兰州大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景与目的肺癌患者在发现时大部分已经处于中晚期阶段,手术的方法已经不能对其进行治疗。热学疗法是一种可以选择的治疗方法。但是热学疗法治疗中晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的有效性和安全性目前没有全面的系统评价。本研究旨在评价热学疗法联合放化疗治疗中晚期非小细胞肺癌的有效性和安全性,并为临床的实践与深入研究提供一定的参考。方法计算机全面检索Cochrane Library、PubMed、EMBASE、CBM、CNKI、VIP和WanFang中有关射频消融或者氩氦刀联合化疗或放化疗治疗中晚期NSCLC的随机对照研究(randomized controlled trials,RCTs)和对照研究,时间截止2014年11月。由两位研究者逐篇评价纳入研究的质量、提取数据并交叉核对,采用RevMan 5.2软件进行数据处理。结果共纳入32项研究,共2687例病人。Meta分析结果显示:与单纯氩氦刀方案相比,氩氦刀联合化疗方案在近期疗效和1、2、3年总体生存率上差异无统计学意义(P0.05);与单纯化疗相比,氩氦刀联合化疗能提高中晚期NSCLC患者的近期疗效和临床受益率(OR=3.02,95%CI:1.91-4.77,P0.00001)、(OR=3.18,95%CI:1.72-5.89,P=0.0002),可以提高中晚期NSCLC患者的1、2年总体生存率(OR=1.99,95%CI:1.23 3.20,P=0.005)、(OR=27.89,95%CI:1.57-494.62,P=0.02);与单纯氩氦刀相比,氩氦刀联合放疗方案能有效提高中晚期NSCLC患者1年的总体生存率(OR=1.77,95%CI:1.03-3.06,P=0.04);与放化疗方案相比,氩氦刀联合放化疗方案能使患者的生存质量得到改善(OR=3.34,95%CI:1.53 7.29,P=0.002)。射频消融联合化疗的6月及1、2、3年总体生存率均优于单纯化疗(OR=5.57,95%CI:2.90-10.70)、(OR=2.01,95%CI:1.41-2.86)、(OR=2.48,95%CI:1.51-4.07)、(OR=2.29,95%CI:1.24-4.22),且差异均有统计学意义(P0.05),两组间并发症及不良反应发生率的差异无统计学意义(P0.05);与放化疗相比,射频消融联合放化疗能提高患者的1年总体生存率(OR=2.09,95%CI:1.11 3.94),并且在能提高患者的KPS评分(OR=3.25,95%CI:1.60 6.61),且差异均有统计学意义(P0.05)。结论与单纯化疗相比,射频消融联合化疗在提高中晚期NSCLC患者生存率上有着明显的优势,并且不增加并发症和不良反应;氩氦刀联合化疗能提高有效性并且安全性较好。与放化疗相比,射频消融联合放化疗能提高患者的生存率和生存质量,且安全性较好;氩氦刀联合放化疗能改善患者的生活质量。与单纯氩氦刀相比,氩氦刀联合放疗能提高其有效性。
[Abstract]:Background and objective the majority of lung cancer patients were in the advanced stage at the time of discovery. Thermotherapy is an alternative treatment. But heat therapy is used in the treatment of advanced non-small cell lung cancer (NSCLC). Non-small cell lung cancer. The efficacy and safety of NSCLC are not systematically evaluated. The purpose of this study was to evaluate the efficacy and safety of thermotherapy combined with radiotherapy and chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC). Methods the Cochrane Library PubMedus EMBASE and CBM Cochrane were searched by computer. [WT5HZ] the results of this study were as follows: (1) in order to provide a reference for the clinical practice and further study, the computer was used to search the Cochrane Library. A randomized controlled study of radiofrequency ablation or argon-helium combined chemotherapy or radiotherapy in VIP and WanFang in the treatment of advanced NSCLC. Randomized controlled trials. RCTs) and the control study, as of November 2014. The two researchers evaluated the quality of the study, extracted the data and cross-checked them one by one. The data were processed by RevMan 5.2 software. The results were included in 32 studies. A total of 2687 patients. Meta-analysis results showed that: compared with the pure argon-helium knife regimen. There was no significant difference in the short-term curative effect and the overall survival rate of 1 ~ 2 and 3 years between argon and helium combined chemotherapy regimen (P 0.05). Compared with chemotherapy alone, argon-helium combined chemotherapy can improve the short-term curative effect and clinical benefit rate of patients with intermediate and advanced NSCLC. P0.00001 and 3.1895% CI: 1.72-5.89% Pao 0.0002 can increase the number of patients with NSCLC in the middle and late stage. The overall 2-year survival rate was 1.99% and 95% CI: 1.23 / 3.20 / P0. 005. The whole 2 year survival rate was 27.89% 95 CI: 1.57-494.62. P0. 02; Compared with Argon-helium alone, Argon-Helium combined radiotherapy can effectively improve the overall survival rate of patients with advanced NSCLC by 1.77% 95 CI: 1.03-3.06. P0. 04; Compared with radiotherapy and chemotherapy, Argon-Helium combined with radiotherapy and chemotherapy can improve the quality of life of patients. The quality of life of patients can be improved by 3.34% 95 CI: 1.53 / 7.29. The overall survival rate of radiofrequency ablation combined with chemotherapy on June and 1 h, 3 years was better than that of chemotherapy alone (5.57% CI: 2.90-10.70). I have an order of 2.41 to 95, and I have an order of 1.41 to 2.86. I have an order of 2.48 and 95. I have a point of 1.51 to 4.07, and I have an order of 2.29. 95 CI: 1.24-4.22, and the differences were statistically significant (P 0.05). There was no significant difference in the incidence of complications and adverse reactions between the two groups (P 0.05). Compared with radiotherapy and chemotherapy, radiofrequency ablation combined with radiotherapy and chemotherapy could improve the overall 1-year survival rate. In addition, the KPS score of the patients was increased by 3.25 ~ 95% CI: 1.60 and 6.61%, and the difference was statistically significant (P 0.05). Conclusion compared with chemotherapy alone. Radiofrequency ablation combined with chemotherapy has obvious advantages in improving the survival rate of patients with advanced NSCLC without increasing complications and adverse reactions. Compared with radiotherapy and chemotherapy, radiofrequency ablation combined with radiotherapy and chemotherapy can improve the survival rate and quality of life of patients, and the safety is better. Argon-helium knife combined with radiotherapy and chemotherapy can improve the quality of life of patients, compared with pure argon-helium knife, Argon-helium combined radiotherapy can improve its effectiveness.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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