| 340 | 3 | 45 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:运用循证医学的方法,系统评价热疗联合化疗方案治疗非小细胞肺癌(NSCLC)的疗效与安全性。方法:检索Cochrane Library、PubMed、EMbase和中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数字化期刊全文数据库,搜集热疗联合化疗对比单纯化疗治疗NSCLC的临床随机对照实验(RCT),检索时限均为从建库至2019年10月,对文献语种不做限定,由两名研究者独立评价并交叉核对纳入文献质量后,采用RevMan5.3版本进行Meta分析。结果:该研究共纳入32个RCT,共2 316例患者,其中试验组1 154例,对照组1 152例。Meta分析结果显示,与单纯化疗组相比,热疗联合化疗方案治疗NSCLC可以提高肿瘤客观缓解率[RR=1.53, 95%CI(1.39,1.69),P<0.01]和改善患者的生活质量[RR=1.67,95%CI(1.46,1.91),P<0.01];在生存率方面,热疗联合化疗治疗NSCLC可以明显提高患者的1年生存率[RR=1.45, 95%CI(1.23,1.71),P<0.01];在降低毒性反应方面,热疗联合化疗组与单纯化疗组相比,热疗联合化疗方案能降低胃肠道反应的发生率[RR=0.76,95%CI(0.63,0.92),P<0.05],但是两组在重度骨髓抑制发生率方面无统计学意义:白细胞毒性[RR=0.73,95%CI(0.48,1.11),P=0.14]和血小板毒性[RR=1.25,95%CI(0.67,2.34),P=0.48]。结论:对于治疗NSCLC,在常规化疗的基础上加用热疗可以增加化疗的近期、远期疗效,提高患者的生存质量,不增加骨髓抑制的发生率。由于纳入研究的文章在质量和数量方面均略有不足,故此结论仍需要开展高质量、多中心、大样本的研究进一步验证其准确性。
Abstract：Objective: To evaluate the effectiveness and safety of hyperthermia combined with chemotherapy for non-small cell lung cancer(NSCLC).Methods: All of randomized controlled trials(RCT) about hyperthermia in combination with chemotherapy(versus chemotherapy alone) were collected through Cochrane library, PubMed, EMbase, CBM, CNKI, VIP, Wanfang Database from database inception to October 2019, no limit on language. Two researchers extracted data and assess literature quality separately, and made a meta-analysis by RevMan 5.3 software. 32 trials with 2361 patients, 1154 in treatment group and 1152 in control group, wereincluded in the review. Results:The results of the Meta-analysis exhibited that compared with chemotherapy alone, hyperthermia combined with chemotherapy could can enhance tumor response rate [RR=1.53, 95% CI(1.39,1.69),P<0.01], improve the quality of life [RR=1.67, 95% CI(1.46,1,91), P<0.01]; one year survival rate [RR=1.45, 95% CI(1.23,1.71),P<0.01]; reduce the gastrointestinal reactions [RR=0.76,95% CI(0.63,0.92),P<0.05]. Meanwhile there was no significant difference in the incidence of severe myelosuppression between the two groups: WBC toxicity [RR=0.73,95% CI(0.48,1.11),P=0.14], Platelet toxicity [RR=1.25,95% CI(0.67,2.34),P=0.48]. Conclusion:The results showed that for the treatment of NSCLC, the addition of hyperthermia to chemotherapy can increase the long-term and short-term effects of chemotherapy, improve the quality of life of patients, and did not significantly increase the incidence of myelosuppression. More high quality and large-scale randomized controlled trials are required in the future.
1 王维琼,2016年中国恶性肿瘤发病和死亡分析[J].临床医药文献杂志,2017,4(19):48.
2 Yang HX,Woo KM,Sima CS,et al.Long-term survival based on the surgical approach to lobectomy for clinical stage i non-small cell lung cancer:comparison of robotic,video assisted thoracic surgery,and thoracotomy lobectomy[J].Annals of Surgery,2017,265(2):1.
3 Yoon SM,Shaikh T,Hallman M.Therapeutic management options for stage Ⅲ non-small cell lung cancer[J].World Journal of Clinical Oncology,2017,8(1):1.
4 丁素银,李青山.肿瘤热疗的基础与临床研究进展[J].承德医学院学报,2010,27(4):415-419.
5 中日医学科技交流协会热疗专业委员会.中国肿瘤热疗临床应用指南(2017.V1.1)[J].中华放射肿瘤学杂志,2017,26(4):369-375.
6 Habash RW,Bansal R,Krewski D,et al.Thermal therapy,part 1:an introduction to thermal therapy[J].Critical Reviews in Biomedical Engineering,2006,34(6):459.
7 古国桂,王小莉,钱华俊.恶性肿瘤患者体外高频热疗的护理体会[J].华北理工大学学报(医学版),2012,14(1):93-94.
8 杨孟祥,赵军,王彦文.BSD2000深部热疗联合PT方案化疗在非小细胞肺癌中的应用[J].中国肺癌杂志,2010,13(2):132-135.
9 王岩静,许齐,曹轶文,等.Np方案化疗与热疗联合治疗非小细胞肺癌的疗效观察[J].临床肺科杂志,2004,(5):458-459.
10 李小江,贾英杰,孙一予,等.NP方案联合局部热疗治疗晚期非小细胞肺癌的临床观察[J].临床肿瘤学杂志,2010,15(8):752-754.
11 Shen H,Li XD ,Wu CP ,et al.The regimen of gemcitabine and cisplatin combined with radio frequency hyperthermia for advanced non-small cell lung cancer:A phase II study[J].International Journal of Hyperthermia,2011,27(1):27-32.
12 张岚,吴江,李佩,等.TP方案联合热疗治疗非小细胞肺癌的疗效观察[J].肿瘤预防与治疗,2008,21(2):150-151.
13 刘阿海,李本全,李发强,等.高频热疗联合TP方案治疗中晚期非小细胞肺癌的疗效观察[J].中国癌症防治杂志,2010,2(2):120-122.
14 武文飞.高频热疗联合吉西他滨治疗老年中晚期非小细胞肺癌效果研究[J].中国现代药物应用,2018,(3):82-83.
15 舒小红,谭榜宪.化疗联合局部区域热疗治疗中晚期非小细胞肺癌[J].临床肿瘤学杂志,2006,(3):218-219.
16 朱江,杨雨,曹丹,等.化疗联合局部热疗治疗晚期非小细胞肺癌[J].中国肿瘤,2007,16(11):943-945.
17 相洁,尹信,贾建厚,等.化疗联合全身热疗治疗Ⅳ期非小细胞肺癌临床观察[J].现代肿瘤医学,2014,22(9):2109-2112.
18 武珊珊,雷军,张洪亮.化疗联合热疗治疗晚期非小细胞肺癌的疗效观察[J].新疆中医药,2012,30(1):24-25.
19 李纲,王中吉,陶莉,等.化疗联合热疗治疗晚期非小细胞肺癌临床探讨[J].现代肿瘤医学,2007,15(6):804-805.
20 温珍平.吉西他滨联合热疗治疗老年晚期tied,细胞肺癌的临床研究[J].现代肿瘤医学,2011,19(5):924-926.
21 任守雷,朱鹏飞,孙文俏,等.经皮微波热消融疗法联合化疗对晚期非小细胞肺癌的治疗效果观察[J].山东医药,2015,(28):96-98.
22 陈学彰,田华琴,梁贵文,等.内生场热疗联合TP方案治疗中晚期非小细胞肺癌的临床观察[J].中国医药指南,2012,10(10):517-519.
23 王立波,赵丽波,席妍,等.全身化疗加局部热疗治疗中晚期非小细胞肺癌[J].实用肿瘤学杂志,2005,(4):293-294.
24 徐岗,王远东,周明.全身热化疗治疗晚期非小细胞肺癌临床研究[J].肿瘤研究与临床,2006,18(10):680-682.
25 李秋梅.热、化疗联合治疗晚期非小细胞肺癌的疗效观察[J].现代肿瘤学,2007,15(12):1782-1783.
26 俞宏伟,张广杰,艾冬梅,等.热化疗对晚期非小细胞肺癌的临床研究[J].河北医药,2012,34(20):3123-3124.
27 于晓旻,李志民.热化疗与化学治疗Ⅲ期非小细胞肺癌临床分析[J].临床荟萃,2012,27(7):597-598.
28 田春桃,张瑞文,范慧娟,等.热疗对晚期非小细胞肺癌化疗增效作用的临床观察[J].肿瘤基础与临床,2013,26(5):406-408.
29 王海存,程鹏.热疗联合NP方案化疗对晚期非小细胞肺癌疗效及免疫力的影响[J].现代中西医结合杂志,2008,(33):5128-5129.
30 陈维,魏涛,陈林.热疗联合TP方案化疗治疗中晚期非小细胞肺癌的临床观察[J].中国医药指南,2014,12(33):33-34.
31 王梅.热疗联合TP方案治疗晚期非小细胞肺癌的临床分析[J].海南医学,2010,21(19):35-37.
32 杨丽,雷君.热疗联合单药化疗治疗老年晚期非小细胞肺癌的临床研究[J].检验医学与临床,2015(3):363-364.
33 张文兵,谢同芳,谢鸿寿,等.热疗联合化疗治疗晚期非小细胞肺癌临床观察[J].肿瘤,2006,26(12):1117-1119.
34 刘海波,曹明,晏云霞,等.热疗联合化疗治疗中晚期非小细胞肺癌的临床观察[J].现代肿瘤医学,2008,16(9):1547-1549.
35 王文辉,蒲怀智,雷小林,等.深部热疗结合化疗治疗晚期非小细胞肺癌疗效观察[J].肿瘤预防与治疗,2009,22(4):395-397.
36 任革,蓝希琼,田华琴.深部热疗联合GP方案化疗治疗晚期非小细胞肺癌患者的疗效观察[J].辽宁中医药大学学报,2015(3):152-154.
37 姚新明,章岳山,安贞兰,等.深部热疗联合化疗治疗晚期非小细胞肺癌的临床分析[J].中华临床医师杂志:电子版,2016(11):105-106.
38 侯燕云,吴艳梅,高宁梅.亚高温全身热疗联合化疗治疗Ⅳ期非小细胞肺癌疗效观察[J].西北药学杂志,2009,24(5):396-397.
39 霍俊杰,吕文格,李曼,等.紫杉醇与顺铂化疗联合深部热疗对局部晚期非小细胞肺癌的疗效影响[J].中国药物经济学,2015,10(5):46-48.
40 蔡琳,Yang Goldstein Binh,Maxwell Parkin Donald,等.东亚地区癌症负担和预防策略[J].肿瘤,2008,28(5):410-414.
41 李佳林,谭小武.晚期非小细胞肺癌的药物治疗方法研究进展[J].临床合理用药杂志,2018,11(5):177-178.
42 Brower V.Afatinib and chemotherapy in non-small-cell lung cancer[J].The Lancet Oncology,2016,17(2):47.
43 蔡忠芳,张晓华,张大海.小剂量紫杉醇联合放疗治疗局部晚期非小细胞肺癌的疗效观察[J].实用肿瘤学杂志,2005,(4):271-272.
44 Wust P,Hildebrandt B,Sreenivasa G,et al.Hyperthermia in combined treatment of cancer[J].Lancet Oncology,2002,3(8):487-497.
45 Martine F,Stalpers LJA,Koper PCM,et al.Long-term improvement in treatment outcome after radiotherapy and hyperthermia in locoregionally advanced cervix cancer:An update of the dutch deep hyperthermia trial[J].International Journal of Radiation Oncology Biology Physics,2008,70(4):1176-1182.
46 Dooley WC,Vargas HI,Fenn AJ,et al.Focused microwave thermotherapy for preoperative treatment of invasive breast cancer:A review of clinical studies[J].Annals of Surgical Oncology,2010,17(4):1076-1093.
47 曾莉敏,赵瑞,李莎,等.三维适形放疗联合微波热疗治疗颈部淋巴结转移癌的疗效观察[J].现代肿瘤医学,2011,19(10):1962-1963.
48 张艳丽,祝顺琴,刘亚玲,等.恶性黑色素瘤内科治疗进展[J].肿瘤防治研究,2014,41(1):74-78.
49 Walther W,Stein U,Schlag PM.Use of the human MDR1 promoter for heat-inducible expression of therapeutic genes[J].International Journal of Cancer,2002,98(2):291-296.
50 Jinsang Y,Hyeong-Reh Choi K,Yong JL.Hyperthermia enhances tumour necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced apoptosis in human cancer cells[J].International Journal of Hyperthermia the Official Journal of European Society for Hyperthermic Oncology North American Hyperthermia Group,2006,22(8):713.
51 Zhang T,Dan Z,Luo Q,et al.Dynamics of blood flow in normal tissue and tumor during local hyperthermia[J].Proceedings of SPIE - The International Society for Optical Engineering,2003,5254:484-491.
52 Osmak M.Induction of heat shock protein 70 in drug-resistant cells by anticancer drugs and hyperthermia[J].Neoplasma,2001,48(2):99-103.
53 Mohamed F,Marchettini P,Stuart OA,et al.Thermal enhancement of new chemotherapeutic agents at moderate hyperthermia [J].Annals of Surgical Oncology,2003,10(4):463-468.
基本信息:
DOI：10.13210/j.cnki.jhmu.20200409.003
中图分类号:R734.2
引用信息:
[1]韩迪,徐泳,冯凡超,等.热疗联合化疗方案治疗非小细胞肺癌的Meta分析[J].海南医学院学报,2020,26(14):1083-1091.DOI:10.13210/j.cnki.jhmu.20200409.003.
基金信息:
江苏省“十二五”中医药重点学科(js1302)~~
2020-04-09
2020-04-09
2020-04-09