Survival of patients with non-small cell lung cancer without treatment: a systematic review and meta-analysis.
Survival of patients with non-small cell lung cancer without treatment: a systematic review and meta-analysis.
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DOI：
10.1186/2046-4053-2-10
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发表时间：
2013-02-04
影响因子：
3.7
通讯作者：
Djulbegovic B
中科院分区：
文献类型：
--
作者：
Wao H;Mhaskar R;Kumar A;Miladinovic B;Djulbegovic B
肺癌被认为是绝症，五年生存率约为16%。与疾病管理相关的明智决策需要对有或没有治疗的疾病进行准确的预后。尽管疾病预后在临床决策中具有重要意义，但尚未对未经治疗的肺癌患者的预后进行系统评估。我们对确诊为肺癌但未经积极治疗的患者的自然史进行了系统回顾和荟萃分析，为从业者提供与疾病相关的管理决策基于证据的建议。具体来说，我们估计了不提供抗癌治疗时的总体生存率。通过搜索电子数据库和摘要程序、审查纳入文章的参考书目以及联系该领域的专家来确定相关研究。所有评估未经治疗的肺癌患者预后的前瞻性或回顾性研究都有资格纳入。死亡率数据是从所有纳入的研究中提取的。使用随机效应模型将死亡率的汇总比例计算为转换比例的加权平均值的反向转换。为了对中位生存期进行荟萃分析，使用已发表的方法将估计值汇总为随机效应模型下的平均值和标准误差。检查了研究的方法学质量。荟萃分析中纳入了 7 项队列研究（4,418 名患者）和 15 项随机对照试验（1,031 名患者）。所有研究均评估了非小细胞肺癌（NSCLC）患者未经治疗的死亡率。在八年和三年的中位研究期间，队列研究中未经治疗的死亡率汇总比例分别为 0.97（95% CI：0.96 至 0.99）和随机对照试验（95% CI：0.94 至 0.98）中的 0.96。将队列和随机对照试验的数据合并后，死亡率的汇总比例为 0.97（95% CI：0.96 至 0.98）。交互作用测试显示队列亚组和随机对照试验之间在统计学上无显着差异。队列研究中未接受抗癌治疗的患者的汇总平均生存期为 11.94 个月（95% CI：10.07 至 13.8），随机对照试验中为 5.03 个月（95% CI：4.17 至 5.89）。对于合并数据（队列研究和随机对照试验），合并平均生存期为 7.15 个月（95% CI：5.87 至 8.42），两种设计之间存在统计学显着差异。总体而言，这些研究的方法学质量中等。对未经治疗的 NSCLC 预后证据的系统评估表明死亡率非常高。未经治疗的肺癌患者平均寿命为 7.15 个月。尽管受到研究设计的限制，这些发现为未来的试验提供了基础，以确定创新疗法对死亡率的最佳预期改善。
Lung cancer is considered a terminal illness with a five-year survival rate of about 16%. Informed decision-making related to the management of a disease requires accurate prognosis of the disease with or without treatment. Despite the significance of disease prognosis in clinical decision-making, systematic assessment of prognosis in patients with lung cancer without treatment has not been performed. We conducted a systematic review and meta-analysis of the natural history of patients with confirmed diagnosis of lung cancer without active treatment, to provide evidence-based recommendations for practitioners on management decisions related to the disease. Specifically, we estimated overall survival when no anticancer therapy is provided. Relevant studies were identified by search of electronic databases and abstract proceedings, review of bibliographies of included articles, and contacting experts in the field. All prospective or retrospective studies assessing prognosis of lung cancer patients without treatment were eligible for inclusion. Data on mortality was extracted from all included studies. Pooled proportion of mortality was calculated as a back-transform of the weighted mean of the transformed proportions using the random-effects model. To perform meta-analysis of median survival, published methods were used to pool the estimates as mean and standard error under the random-effects model. Methodological quality of the studies was examined. Seven cohort studies (4,418 patients) and 15 randomized controlled trials (1,031 patients) were included in the meta-analysis. All studies assessed mortality without treatment in patients with non-small cell lung cancer (NSCLC). The pooled proportion of mortality without treatment in cohort studies was 0.97 (95% CI: 0.96 to 0.99) and 0.96 in randomized controlled trials (95% CI: 0.94 to 0.98) over median study periods of eight and three years, respectively. When data from cohort and randomized controlled trials were combined, the pooled proportion of mortality was 0.97 (95% CI: 0.96 to 0.98). Test of interaction showed a statistically non-significant difference between subgroups of cohort and randomized controlled trials. The pooled mean survival for patients without anticancer treatment in cohort studies was 11.94 months (95% CI: 10.07 to 13.8) and 5.03 months (95% CI: 4.17 to 5.89) in RCTs. For the combined data (cohort studies and RCTs), the pooled mean survival was 7.15 months (95% CI: 5.87 to 8.42), with a statistically significant difference between the two designs. Overall, the studies were of moderate methodological quality. Systematic evaluation of evidence on prognosis of NSCLC without treatment shows that mortality is very high. Untreated lung cancer patients live on average for 7.15 months. Although limited by study design, these findings provide the basis for future trials to determine optimal expected improvement in mortality with innovative treatments.