放疗联合EGFR-TKIs治疗非小细胞肺癌脑转移疗效及安全性的meta分析

发布时间：2019-04-15 18:38

【摘要】：目的:应用meta分析评估放疗联合EGFR-TKIs对比放疗治疗非小细胞肺癌脑转移的疗效及安全性。方法:在Pubmed数据库、Embase数据库、中国生物医学文献数据库、中国知网、万方医学网等数据中,使用主题词加自由词的检索策略,检索出放疗联合EGFR-TKIs对比放疗治疗非小细胞肺癌脑转移的前瞻性临床对照试验。严格按照纳入标准及排除标准筛选文献,并使用改良Jadad量表对纳入文献进行质量评价,提取纳入文献中的主要数据,应用Revman5.3软件及Stata 12.0软件对提取数据进行meta分析,并同时对结果进行敏感性分析及发表偏倚分析。结果:最终纳入7篇文献,其中随机对照临床试验6篇,非随机对照试验1篇,试验组EGFR-TKIs联合放疗治疗共254例,对照组单纯放疗或单纯放疗联合安慰剂治疗共245例。Meta分析结果显示:EGFR-TKI+RT组对比RT组,在肿瘤缓解方面,联合组的客观缓解率ORR以及疾病控制率DCR要高于RT组[ORR(RR=1.82,95%CI:[1.47,2.26],P0.00001),DCR(RR=1.30,95%CI:[1.17,1.45],P0.00001)];在肿瘤患者预后生存方面,联合组的1年总生存率以及中位生存期高于RT组,但差异都无统计学意义[1年总生存率(RR=1.69,95%CI:[0.97,2.95],P=0.06),m OS(MSR=1.134,95%CI:[0.653,1.969],P=0.656)];在治疗毒副反应方面,联合组患者发生皮疹、腹泻的概率要明显高于RT组,[Rash(RR=18.06,95%CI:[6.77,48.16],P0.00001),Dirrahoea(RR=3.98,95%CI:[1.99,7.95],P0.0001)]。结论:在非小细胞肺癌脑转移的患者中,放疗联合EGFR-TKI治疗患者的客观缓解率ORR、疾病控制率DCR明显高于单纯放疗组,但联合组在改善患者的1年总生存率及中位生存期方面并没有优势,且联合组患者发生皮疹、腹泻等毒副作用的概率更高。
[Abstract]:Objective: to evaluate the efficacy and safety of radiotherapy combined with EGFR-TKIs in the treatment of brain metastasis from non-small cell lung cancer (NSCLC) by meta analysis. Methods: in Pubmed database, Embase database, Chinese biomedical literature database, Chinese knowledge website, Wanfang Medical Network and other data, the retrieval strategy of subject words and free words was used. A prospective clinical controlled trial of radiotherapy combined with EGFR-TKIs in the treatment of brain metastasis from non-small cell lung cancer was searched. According to the criteria of inclusion and exclusion, the quality of the documents was evaluated by the modified Jadad scale, the main data were extracted, and the extracted data were analyzed by meta with Revman5.3 software and Stata 12.0 software, and the quality of the data was evaluated by using the modified Revman5.3 scale. At the same time, the results were analyzed by sensitivity analysis and publication bias analysis. Results: seven articles were included, including 6 randomized controlled clinical trials and 1 non-randomized controlled trial. There were 254patients treated with EGFR-TKIs combined with radiotherapy in the trial group. The results of Meta-analysis showed that the EGFR-TKI RT group was better than the RT group in tumor remission, and the results of meta-analysis showed that the patients in the control group were treated with radiotherapy alone or radiotherapy alone combined with placebo. Objective remission rate (ORR) and disease control rate (DCR) in the combined group were higher than those in the RT group [ORR (RR=1.82,95%CI: [1.47, 2.26], P0.00001), DCR (RR=1.30,95%CI: [1.17,1.45], P0.00001); In terms of prognosis and survival, the 1-year overall survival rate and median survival time in the combined group were higher than those in the RT group, but there was no significant difference between the two groups [1-year overall survival rate (RR=1.69,95%CI: [0.97, 2.95], P < 0.05). M OS (MSR=1.134,95%CI: [0.653, 1.969], P = 0.656); In the treatment of toxic side effects, the incidence of diarrhea in the combined group was significantly higher than that in the RT group, [Rash (RR=18.06,95%CI: [6.77,48.16], P0.00001), Dirrahoea (RR=3.98,95%CI: [1.99,7.95], P 0.0001). Conclusion: in patients with brain metastasis from non-small cell lung cancer, the objective remission rate of patients treated with radiotherapy combined with EGFR-TKI was significantly higher than that of patients treated with radiotherapy alone. The rate of ORR, disease control was significantly higher than that of radiotherapy alone. However, the combined group had no advantage in improving the overall 1-year survival rate and the median survival time, and the combined group had a higher probability of side effects such as rash and diarrhoea.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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