晚期非小细胞肺癌患者的单药化疗与联合化疗：反应、毒性和生存的荟萃分析

Single agent versus combination chemotherapy in patients with advanced nonsmall cell lung carcinoma: a meta-analysis of response, toxicity, and survival.

作者信息

Lilenbaum R C, Langenberg P, Dickersin K

机构信息

University of Maryland Cancer Center, Baltimore, USA.

出版信息

Cancer. 1998 Jan 1;82(1):116-26. doi: 10.1002/(sici)1097-0142(19980101)82:1<116::aid-cncr14>3.0.co;2-5.

DOI:10.1002/(sici)1097-0142(19980101)82:1<116::aid-cncr14>3.0.co;2-5

PMID:9428487

Abstract

BACKGROUND

This meta-analysis was conducted to compare the effects of single agent versus combination chemotherapy on response rate, toxicity, and survival of patients with advanced nonsmall cell lung carcinoma (NSCLC).

METHODS

The authors reviewed randomized clinical trials published in the medical literature and the reference lists of relevant articles. Objective response rate, survival at 6 and 12 months, and the incidence of treatment-related death were compared among all patients receiving single agent chemotherapy and those receiving combination chemotherapy. A subgroup analysis for all outcomes was conducted for 10 trials published between 1989 and 1996 that used a platinum analogue or vinorelbine as the single agent arm.

RESULTS

The authors identified 38 potentially eligible trials, 25 of which (with a total of 5156 patients) were included in the meta-analysis. Overall, combination chemotherapy produced a nearly 2-fold increase in response rate compared with single agent chemotherapy (response rate [RR], 1.93; 95% confidence interval [CI], 1.54-2.42). However, combination chemotherapy also increased toxicity significantly, including a 3.6-fold increase in the risk of treatment-related death (RR, 3.5; 95% CI, 1.8-6.7). Survival at 6 months (RR, 1.10; 95% CI, 1.02-1.19) and 12 months (RR, 1.22; 95% CI, 1.03-1.45) was modestly superior with combination chemotherapy when all trials are included. However, when a platinum analogue or vinorelbine are used as single agents, this difference was no longer statistically significant at 6 months (RR, 1.03; 95% CI, 0.92-1.15) or at 12 months (RR, 1.10; 95% CI, 0.94-1.43).

CONCLUSIONS

Combination chemotherapy increased objective response and toxicity rates compared with single-agent chemotherapy. Survival was prolonged only modestly with combination chemotherapy but not significantly so when more active single agents were used.

摘要

背景

本荟萃分析旨在比较单药化疗与联合化疗对晚期非小细胞肺癌（NSCLC）患者缓解率、毒性和生存率的影响。

方法

作者回顾了医学文献及相关文章参考文献列表中发表的随机临床试验。比较了所有接受单药化疗患者与接受联合化疗患者的客观缓解率、6个月和12个月生存率以及治疗相关死亡发生率。对1989年至1996年间发表的10项试验进行了所有结局的亚组分析，这些试验将铂类类似物或长春瑞滨作为单药治疗组。

结果

作者确定了38项可能符合条件的试验，其中25项（共5156例患者）纳入了荟萃分析。总体而言，与单药化疗相比，联合化疗使缓解率提高了近2倍（缓解率[RR]，1.93；95%置信区间[CI]，1.54 - 2.42）。然而，联合化疗也显著增加了毒性，包括治疗相关死亡风险增加了3.6倍（RR，3.5；95% CI，1.8 - 6.7）。当纳入所有试验时，联合化疗在6个月（RR，1.10；95% CI，1.02 - 1.19）和12个月（RR，1.22；95% CI，1.03 - 1.45）的生存率略高。然而，当将铂类类似物或长春瑞滨用作单药时，这种差异在6个月（RR，1.03；95% CI，0.92 - 1.15）或12个月（RR，1.10；95% CI，0.94 - 1.43）时不再具有统计学意义。