埃克替尼联合放疗治疗肺癌脑转移疗效和安全性的Meta分析

doi:10.3969/j.issn.1004-583X.2018.08.014

临床荟萃

埃克替尼联合放疗治疗肺癌脑转移疗效和安全性的Meta分析

昆明医科大学第三附属医院云南省肿瘤医院胸外科，云南昆明 650100

出版日期:2018-08-05 发布日期:2018-09-10
通讯作者: 通信作者：李高峰，Email:ligaofenghl@126.com
基金资助:
国家自然科学基金地区科学基金项目(81460356)

Efficacy and safety of icotinib combined with radiotherapy in the treatment of lung cancer with brain metastasis: a metaanalysis

Department of Thoracic Surgery, the Third Affiliated Hospital, Kunming Medical University/Tumor Hospital of Yunan Province, Kunming 650100, China

Online:2018-08-05 Published:2018-09-10
Contact: Corresponding author: Li Gaofeng，Email: ligaofenghl@126.com

摘要/Abstract

摘要： 目的系统评价埃克替尼联合放疗治疗肺癌脑转移的疗效和安全性,为临床应用提供科学依据。方法计算机检索Cochrane Library、PubMed、EMbase、CBM和万方、维普、CNKI数据库,检索时限为2011年1月1日至2018年5月1日,收集关于埃克替尼联合放疗对比单纯放疗治疗肺癌脑转移的相关文献。由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入5篇临床对照研究，包括281例患者。Meta分析结果显示:埃克替尼联合放疗组治疗肺癌脑转移患者的完全缓解(CR)(OR=2.69,95%CI=1.30~5.58,P=0.008)、部分缓解(PR)(OR=2.28,95%CI=1.40~3.71,P=0.0009)、总有效率(ORR)(OR=4.16,95%CI=2.26~7.67,P=0.00001)和疾病控制率(DCR)(OR=3.97,95%CI=1.70~9.26,P=0.001)均明显高于单纯放疗组;而疾病进展(PD)(OR=0.30,95%CI=0.14~0.62,P=0.001)和病变稳定(SD)(OR=0.39,95%CI=0.22~0.69,P=0.001)低于单纯放疗组。另外,埃克替尼联合放疗组较单纯放疗组增加了皮疹（OR=6.79,95%CI=3.40~13.55,P=0.00001）和腹泻（OR=2.57,95%CI=1.09~6.04,P=0.03）发生风险，两组其他不良反应如白细胞减少（P=0.70）、恶心呕吐（P=0.20）、肝功能损伤（P=0.32）差异无统计学意义(P>0.05)。结论埃克替尼联合放疗治疗肺癌脑转移有较好临床疗效,同时，其发生皮疹及腹泻的风险较高，经过对症处理后可缓解，其他不良反应如白细胞减少、恶心呕吐、肝功能损伤差异无统计学意义，其安全性可靠。

关键词: 肺肿瘤, 脑转移, 埃克替尼, 化放疗, meta分析

Abstract: Objective To evaluate the efficacy and safety of icotinib combined with radiotherapy in the treatment of lung cancer with brain metastasis. Methods The Cochrane Library, PubMed, EMbase, CBM, VIP, CNK and WanFang Data were searched for the references on icotinib combined with radiotherapy in the treatment of lung cancer with brain metastases published from the date of January 2011 to July 2017. According to the inclusion and exclusion criteria, two reviewers screened the studies independently, extracted the data and assessed the quality. Then, RevMan 5.3 software was used for meta analysis.Results A total of 5 clinical control studies involving 281 patients were included. The results of metaanalysis showed that icotinib combined with radiotherapy may contribute to higher CR as compared with the group treated with radiotherapy only(OR=2.69, 95%CI=1.305.58, P=0.008) and PR (OR=2.28, 95%CI=1.403.71, P=0.0009) rates, ORR(OR=4.16, 95%CI=2.267.67, P=0.00001), and DCR
(OR=3.97, 95%CI=1.709.26, P=0.001), and lower PD(OR=0.30, 95%CI=0.140.62, P=0.001) and SD (OR=0.39, 95%CI=0.220.69,P=0.001) rates for lung cancer patients with brain metastases. Moreover, the group of icotinib combined with radiotherapy increases the risk of erythra (OR=6.79, 95%CI=3.4013.55, P<0.05) and diarrhea (OR=2.57, 95%CI=1.096.04, P=0.03). There were no significant differences in leukopenia (P=0.70), nausea and vomiting(P=0.20), and liver function impairment(P=0.32，P>0.05) between the two groups.Conclusion Icotinib combined with radiotherapy is more effective than monotherapy for lung cancer with brain metastasis. Meanwhile, the group of icotinib combined with radiotherapy increases the risk of erythra and diarrhea which can be alleviated after expectant treatment. There were no significant differences between the two groups in leukopenia, nausea and vomiting, liver function impairment. The therapy is safe and reliable.

Key words: lung neoplasms, brain metastases; , icotinib, chemoradiotherapy, metaanalysis

陈本超，李恒，向旭东，李高峰，傅峰，郭琦，范胜亮，王德光. 埃克替尼联合放疗治疗肺癌脑转移疗效和安全性的Meta分析[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.08.014.

Chen Benchao, Li Heng, Xiang Xudong, Li Gaofeng, Fu Feng, Guo Qi，Fan Shengliang，Wang Deguang. Efficacy and safety of icotinib combined with radiotherapy in the treatment of lung cancer with brain metastasis: a metaanalysis[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.08.014.

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https://huicui.hebmu.edu.cn/CN/Y2018/V33/I8/705

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埃克替尼联合放疗治疗肺癌脑转移疗效和安全性的Meta分析

Efficacy and safety of icotinib combined with radiotherapy in the treatment of lung cancer with brain metastasis: a metaanalysis

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