EGFR突变阴性非小细胞肺癌二、三线治疗的荟萃分析-东南大学学报医学版

EGFR突变阴性非小细胞肺癌二、三线治疗的荟萃分析

单位：1. 南方医科大学珠江医院肿瘤中心, 广东广州 510282;
2. 宁波市第二医院介入科, 浙江宁波 315099

分类号：R734.2

出版年·卷·期（页码）：2015·34·第六期（859-867）

摘要：

目的:比较酪氨酸激酶抑制剂(TKIs)与二线或三线化疗治疗表皮生长因子受体(EGFR)突变阴性的非小细胞肺癌(NSCLC)患者的疗效.方法:检索PubMed、Cochrane Library、EMBASE、中国知网和美国临床肿瘤学会(ASCO)会议摘要,对符合要求的随机对照试验进行荟萃分析.结果:共纳入7个试验,结局指标包括从随机化分配到疾病进展的时间(PFS)和从方案招募开始到患者死亡的时间(OS).PFS指标显示,TKIs在统计学上差于化疗(风险比HR=1.34, 95% CI为1.08~1.65; P=0.007);OS指标显示,两者差异无统计学意义(HR=1.07, 95% CI为0.92~1.24; P=0.395).移除2个试验后,PFS指标显示,TKIs仍然差于化疗(风险比HR=1.42, 95% CI为1.23~1.63; P=0.000);OS指标显示,两者差异无统计学意义(HR=1.05, 95% CI为0.90~1.23; P=0.536).所有亚组中厄洛替尼对比化疗差异均无统计学意义.结论:对于EGFR突变阴性且可耐受化疗的NSCLC患者,化疗优于TKIs治疗,但是TKIs可用于体力状况评分差的患者.

Objective: To compare the efficacy of TKIs with chemotherapy in second-line or third-line treatment for EGFR mutation-negative NSCLC patients. Methods: PubMed, Cochrane Library, EMBASE, CNKI and abstracts from the proceedings of ASCO were searched to identify randomized controlled clinical trials. Results: 7 randomized controlled trials were identified eligible for meta-analysis. The outcomes of treatment efficacy included PFS and OS. TKIs were statistically significant inferior to chemotherapy in PFS (hazard ratio (HR)=1.34, 95% confidence interval (CI)=1.08-1.65; P=0.007). However, no statistically significant difference in OS was found (HR=1.07, 95% CI=0.92-1.24; P=0.395). After removing two trials, the results were not obviously different for both PFS (HR=1.42, 95% CI=1.23-1.63; P=0.000) and OS (HR=1.05, 95% CI=0.90–1.23; P=0.536). Erlotinib was not statistically significantly different from chemotherapy in very subgroup. Conclusion: For EGFR mutation-negative NSCLC patients, chemotherapy should take precedence over TKIs for those who can tolerant chemotherapy, while TKIs can be options for patients with poor performance status.

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