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目的:对联合铂类的双药方案和非铂类单药方案一线治疗老年晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的有效性及安全性进行Meta分析。方法:计算机检索PubMed、EMbase、Cochrane Library、中国期刊全文数据库(CNKI)和中国生物医学文献数据库(CBMdice),收集以含铂双药方案对比非铂单药方案治疗老年晚期NSCLC的随机对照试验,用RevMan5.2软件对数据进行Meta分析。结果:共纳入12项随机对照试验(753例病例),Meta分析结果显示,与非铂单药方案相比,含铂双药方案化疗可提高老年晚期NSCLC患者的化疗客观有效率1.37倍,两者差异有统计学意义(RR=1.37,95%CI:1.12～1.69,P=0.002),但两组1年生存率差异无统计学意义,RR=1.07,95%CI:0.91～1.27,P=0.41;并且含铂双药组更易发生3～4级白细胞减少(RR=2.33,95%CI:1.62～3.35,P<0.01)、3～4级中性粒细胞减少(RR=3.09,95%CI:1.72～5.53,P=0.000 1)、3～4级血小板减少(RR=2.96,95%CI:1.58～5.54,P=0.000 07)和3～4级恶心呕吐(RR=4.89,95%CI:2.46～9.72,P<0.01)等不良反应,差异均有统计学意义。结论:与非铂单药方案相比,含铂双药方案可提高化疗有效率,但不能改善1年生存率,且含铂双药组发生3～4级不良反应的可能性更大,故不适合作为老年晚期NSCLC一线化疗方案,但这一结论仍需开展针对老年晚期NSCLC患者的大样本随机对照试验加以验证。
OBJECTIVE: To conduct a meta-analysis of the efficacy and safety of first-line treatment of elderly patients with advanced non-small cell lung cancer (NSCLC) in combination with a dual-agent platinum regimen and a non-platinum regimen. METHODS: PubMed, EMbase, Cochrane Library, Chinese Journal Full-text Database (CNKI) and Chinese Biomedical Literature Database (CBMdice) were searched by computer. Randomized controlled trials were conducted to compare the efficacy of non-platinum single drug regimen with non-platinum single drug regimen in elderly patients with advanced non-small cell lung cancer Meta-analysis of data using RevMan5.2 software. Results: A total of 12 randomized controlled trials (753 cases) were included. The results of Meta analysis showed that compared with the non-platinum single-agent regimen, the double-platinum regimen chemotherapy increased the objective response rate of chemotherapy in elderly patients with advanced stage NSCLC by 1.37 times, (RR = 1.37, 95% CI: 1.12-1.69, P = 0.002). However, there was no significant difference in one-year survival rate between the two groups (RR = 1.07, 95% CI: 0.91-1.27, P = 0.41; and the platinum-containing two-drug group more prone to grade 3-4 leukopenia (RR = 2.33,95% CI: 1.62 to 3.35, P <0.01), grade 3 to 4 neutropenia (RR = 3.09,95 (RR = 2.96, 95% CI: 1.58-5.54, P = 0.0007) and grade 3 to 4 nausea and vomiting (RR = 4.89, 95% CI: 1.72-5.53, P = 0.0001) % CI: 2.46 ~ 9.72, P <0.01) and other adverse reactions, the differences were statistically significant. Conclusion: Compared with the non-platinum single drug regimen, the platinum-containing double-drug regimen can improve the chemotherapy efficiency, but can not improve the 1-year survival rate, and the platinum-containing double-drug group is more likely to have grade 3 to 4 adverse reactions. Not suitable as a first-line chemotherapy for elderly patients with advanced NSCLC, but this conclusion still needs to be carried out for elderly patients with advanced NSCLC large sample randomized controlled trials to be verified.