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目的系统评价外周血干细胞支持下大剂量化疗(APBSCT+HDC)治疗小细胞肺癌(SCLC)的疗效及安全性。方法计算机检索MEDLINE(1970～2011.1)、EMbase(1980～2011.1)、Science Direct(1980～2011.1)、Cochrane图书馆(2010年第3期)、CNKI、CBM和WanFang Data(检索截至2010年12月),查找APBSCT+HDC治疗SCLC的随机对照试验(RCT)。按纳入与排除标准选择试验、提取资料和评价方法学质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入6个RCT,737例患者,其方法学质量评级B级5篇,C级1篇。Meta分析结果显示:APBSCT+HDC治疗SCLC的总有效率和总生存率明显优于常规化疗,其差异有统计学意义[分别为RR=1.14,95%CI(1.07,1.21),P<0.000 1;RR=3.74,95%CI(2.13,6.58),P<0.000 01]。在Ⅲ/Ⅳ度红细胞及血小板降低的发生率方面,APBSCT+HDC治疗组高于常规化疗组,差异有统计学意义[分别为RR=1.97,95%CI(1.15,3.38),P=0.01;RR=1.93,95%CI(1.06,3.54),P=0.03];但在Ⅲ/Ⅳ度白细胞降低方面,两组差异无统计学意义。结论与常规化疗相比,APBSCT+HDC治疗SCLC能提高总有效率及总生存率,但有增加重度血液学毒副反应发生率的风险。因本研究纳入样本量较少,方法学质量不够高,故所得结论尚需更多高质量多中心大样本RCT证实。
Objective To evaluate the efficacy and safety of high-dose chemotherapy (APBSCT + HDC) with peripheral blood stem cells in the treatment of small cell lung cancer (SCLC). Methods Genomic DNA was searched by MEDLINE (1970 ~ 2011.1), EMbase (1980 ~ 2011.1), Science Direct (1980 ~ 2011.1), The Cochrane Library (2010), CNKI, CBM and WanFang Data (retrieved as of December 2010) , Looking for a randomized controlled trial (RCT) of APBSCT + HDC for the treatment of SCLC. Meta-analysis was performed using RevMan 5.0 software after selecting trials based on inclusion and exclusion criteria, extracting data, and evaluating methodological quality. Results A total of 6 RCTs and 737 patients were enrolled in this study. The methodological quality was rated as Grade B in Grade B and Grade C in 1. The results of Meta analysis showed that the total effective rate and overall survival rate of APLCCT + HDC in treating SCLC were significantly better than those of conventional chemotherapy (RR = 1.14,95% CI (1.07,1.21, P <0.0001 ; RR = 3.74, 95% CI (2.13, 6.58), P <0.000 01]. In terms of the incidence of Ⅲ / Ⅳ erythrocytes and thrombocytopenia, the APBSCT + HDC treatment group was higher than the conventional chemotherapy group with statistically significant differences (RR = 1.97, 95% CI 1.15, 3.38, P 0.01) RR = 1.93, 95% CI (1.06, 3.54), P = 0.03]. However, there was no significant difference between the two groups in the degree of Ⅲ / Ⅳ leukopenia. Conclusion Compared with conventional chemotherapy, APBSCT + HDC treatment of SCLC can improve the total effective rate and overall survival rate, but increase the risk of severe hematological toxicities. Due to the small sample size and poor methodological quality of the study, more high-quality, multi-center RCTs are still required.