EGFR野生型及EGFR未知突变状态的非小细胞肺癌后续治疗的网状meta分析

发布时间：2018-05-18 16:05

本文选题：非小细胞肺癌 + EGFR野生型　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:对目前EGFR野生型及EGFR未知突变状态的非小细胞肺癌的后续治疗(即二、三线治疗)进行网络meta分析。方法:制定检索策略,通过检索数据库如MEDLINE(1966-2015.11)、EMBASE(1980-2015.11)、Web of Science(1990-2015)、CENTRAL(-2015.11)、google学术及clinicaltrial.gov等,同时补充其他检索方式,例如检索相关文献的参考文献,最终获取所有有关表皮生长因子受体(epidermal growth factor receptor,EGFR)野生型及EGFR未知突变状态(即未进行EGFR突变检测)的非小细胞肺癌后续治疗的随机对照试验研究,导入检索文献,并通过初筛、全文筛选,纳入符合要求的文献全文,对纳入研究的基本信息、研究对象特征、干预措施、结局指标等进行综合、分类,制定研究特征表,采用cochrane偏倚风险评价工具对研究进行偏倚风险评价,用Revman软件制作偏倚风险评估详细表格及总结图,用Fast Stone、Adobe Photoshop、Enguage Digital 4.1等软件提取数据,运用WinBugs、STATA等软件进行网络meta分析,制作网络图、网络meta结果表格,并对网络meta分析进行不一致性和相似性比较,结果采用总存活数(overall survival,OS)、无进展生存时间(Progress Free Survival,PFS)作为研究结局。结果:共检索到12501篇文章,其中符合本研究纳入标准的文章为21篇,总共9335位受试者,纳入研究的药物包括多西他赛、培美曲赛、厄洛替尼、吉非替尼、雷莫芦单抗、尼鲁单抗、安慰剂、最佳支持治疗。在总存活数方面,有2篇研究分配到尼鲁单抗组,11篇研究分配到多西他赛组,8篇研究分配到吉非替尼组,8篇研究分配到培美曲赛组,8篇研究分配到厄洛替尼组,4篇研究分配到安慰剂组,1篇研究分配到雷莫芦单抗组。网络meta分析结果显示:与对照组(安慰剂或最佳支持治疗)相比,单药尼鲁单抗组(nivolumab)(hr0.56,cri0.42-0.74)、多西他赛组(docetaxel)(hr0.83,cri0.7-0.99)、厄洛替尼组(erlotinib)(hr0.76,cri0.63-0.91)增高了总存活数,并且,将尼鲁单抗组与多西他赛组(hr0.67,cri0.54-0.83)、厄洛替尼组(hr0.74,cri0.56-0.97)、吉非替尼组(gefitinib)(hr0.69,cri0.54-0.89)、培美曲赛组(pemetrexed)(hr0.70,cri0.54-0.92)、雷莫芦单抗(ramucirumab)组(hr0.65,cri0.45-0.92)比较,尼鲁单抗组的总存活数更高。而在无进展生存时间中,网络meta分析未发现明显统计学意义。结论:在egfr野生型或未知egfr突变状态的非小细胞肺癌后续治疗中,在总存活数方面,与对照组相比,单药尼鲁单抗、多西他赛、厄洛替尼增高了总存活数;并且,单药尼鲁单抗在提高总存活数上优于多西他赛、培美曲赛、厄洛替尼、吉非替尼、雷莫芦单抗等药物。而其他单药的相互比较(如:多西他赛组vs厄洛替尼组;培美曲赛组vs厄洛替尼组;多西他赛组vs培美曲赛组)在总存活数及无进展生存时间上均无明显差异。
[Abstract]:Objective: to analyze the status of EGFR wild-type and EGFR unknown mutation in non-small cell lung cancer (NSCLC) by network meta analysis. Methods: a search strategy was drawn up through searching databases such as MEDLINE (1966-2015.11) and Web of Science (1980-2015). Meanwhile, other retrieval methods, such as references to relevant literature, were supplemented by Google academic and clinicaltrial.gov. Finally, all randomized controlled trial studies on the wild type of epidermal growth factor receptor (EGFR) and the unknown mutation status of EGFR (that is, no EGFR mutation detection) were obtained. Full text screening, including the full text of the documents that meet the requirements, the synthesis, classification, and development of research feature tables of the basic information, the characteristics of the research objects, the intervention measures, the outcome indicators, etc. Cochrane bias risk assessment tool was used to evaluate the bias risk of the study. The detailed form and summary chart of bias risk assessment were made with Revman software. The data were extracted by Fast Stonehmmer Photoshop Digital 4.1, and the network meta analysis was carried out by using WinBugsStella STATA and other software. The network diagram, network meta result table, and the inconsistency and similarity of network meta analysis were compared. The results were as follows: the total survival number was overall survival Free, and no progress survival time was used as the result of the study. Results: a total of 12501 articles were retrieved, of which 21 were eligible for inclusion in this study, and a total of 9335 subjects were included in the study. The drugs included in the study included docetaxel, pemetrexide, erlotinib, gefitinib, remolumab. Neilumab, placebo, best support treatment. In terms of total survival, Two studies were assigned to the Neurumab group 11 studies were assigned to the docetaxel group 8 studies to the gefitinib group eight studies to the pemetrel group eight studies to the erlotinib group and four studies to consolation One study was assigned to the laminumab group. The results of network meta analysis showed that compared with the control group (placebo or best support therapy), Nilumab group increased the total number of survivors, and the docetaxellosil group (docetaxellosil 0.83 cri0.7-0.99), the erlotinib 0.76hr0.66cri3-0.91 group increased the total number of survivors, and, in the docetaxellosil group, the total number of survivors was increased, and the total number of survivors in the single drug Nilumab group was higher than that in the control group (placebo or the best supportive therapy), and there was no significant difference between the two groups. The total survival number of niluximab group was higher than that of doxitaxel group (0.54-0.83), erlotinib group (0.56-0.97), gefitinibtib group (0.54-0.89), pemetrexedhr0.70 cri0.54-0.92( nilumab group). The total survival number of nilumab group was higher than that of pemetrexedhr0.70 cri0.54-0.92 group (P < 0.05). However, no significant statistical significance was found in network meta analysis in the absence of progressive survival time. Conclusion: in the follow-up treatment of non-small cell lung cancer with egfr wild type or unknown egfr mutation status, the total survival rate was increased by single drug Nilumab, docetaxel and erlotinib in comparison with the control group. Neilumab was superior to docetaxel, pemetrexide, erlotinib, gefitinib and remolumab in improving total survival. There was no significant difference in the total survival rate and the survival time without progress between the two groups (e. G. Docetaxel vs erlotinib; pemetrexide vs erlotinib; docetaxel vs pemetrel).
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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