Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, China.
PLoS One. 2013 Aug 30;8(8):e73805. doi: 10.1371/journal.pone.0073805. eCollection 2013.
Maintenance chemotherapy is widely provided to patients with small cell lung cancer (SCLC). However, the benefits of maintenance chemotherapy compared with observation are a subject of debate.
To identify relevant literature, we systematically searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Eligible trials included patients with SCLC who either received maintenance chemotherapy (administered according to a continuous or switch strategy) or underwent observation. The primary outcome was 1-year mortality, and secondary outcomes were 2-year mortality, overall survival (OS), and progression-free survival (PFS). Of the 665 studies found in our search, we identified 14 relevant trials, which together reported data on 1806 patients with SCLC. When compared with observation, maintenance chemotherapy had no effect on 1-year mortality (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.66-1.19; P = 0.414), 2-year mortality (OR: 0.82; 95% CI: 0.57-1.19; P = 0.302), OS (hazard ratio [HR]: 0.87; 95% CI: 0.71-1.06; P = 0.172), or PFS (HR: 0.87; 95% CI: 0.62-1.22; P = 0.432). However, subgroup analyses indicated that maintenance chemotherapy was associated with significantly longer PFS than observation in patients with extensive SCLC (HR, 0.72; 95% CI: 0.58-0.89; P = 0.003). Additionally, patients who were managed using the continuous strategy of maintenance chemotherapy appeared to be at a disadvantage in terms of PFS compared with patients who only underwent observation (HR, 1.27; 95% CI: 1.04-1.54; P = 0.018).
CONCLUSIONS/SIGNIFICANCE: Maintenance chemotherapy failed to improve survival outcomes in patients with SCLC. However, a significant advantage in terms of PFS was observed for maintenance chemotherapy in patients with extensive disease. Additionally, our results suggest that the continuous strategy is inferior to observation; its clinical value needs to be investigated in additional trials.
小细胞肺癌（SCLC）患者广泛接受维持化疗。然而，维持化疗与观察相比是否具有优势存在争议。
为了确定相关文献，我们系统地检索了 Medline、Embase 和 Cochrane 对照试验中心注册库。合格试验包括接受维持化疗（根据连续或转换策略给予）或观察的 SCLC 患者。主要结局为 1 年死亡率，次要结局为 2 年死亡率、总生存期（OS）和无进展生存期（PFS）。在我们的检索中，共发现 665 项研究，其中 14 项相关试验共报告了 1806 例 SCLC 患者的数据。与观察相比，维持化疗对 1 年死亡率（比值比[OR]：0.88；95%置信区间[CI]：0.66-1.19；P=0.414）、2 年死亡率（OR：0.82；95%CI：0.57-1.19；P=0.302）、OS（风险比[HR]：0.87；95%CI：0.71-1.06；P=0.172）或 PFS（HR：0.87；95%CI：0.62-1.22；P=0.432）没有影响。然而，亚组分析表明，在广泛期 SCLC 患者中，维持化疗与观察相比，PFS 显著延长（HR：0.72；95%CI：0.58-0.89；P=0.003）。此外，与仅接受观察的患者相比，接受维持化疗连续策略治疗的患者在 PFS 方面似乎处于劣势（HR：1.27；95%CI：1.04-1.54；P=0.018）。
结论/意义：维持化疗并未改善 SCLC 患者的生存结局。然而，广泛期疾病患者的 PFS 显著获益于维持化疗。此外，我们的结果表明，连续策略不如观察，需要在进一步的试验中研究其临床价值。
