Adjuvant Chemotherapy for the Completely Resected Stage IB Nonsmall Cell Lung Cancer: A Systematic Review and Meta-Analysis.
Adjuvant Chemotherapy for the Completely Resected Stage IB Nonsmall Cell Lung Cancer: A Systematic Review and Meta-Analysis.
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DOI：
10.1097/md.0000000000000903
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发表时间：
2015-06
期刊：
影响因子：
1.6
通讯作者：
He J
中科院分区：
文献类型：
--
作者：
He J;Shen J;Yang C;Jiang L;Liang W;Shi X;Xu X;He J
补充数字内容可在文本辅助化疗建议术后II-IIIB期非小细胞肺癌患者。然而，其在IB期患者中的作用仍存在争议。因此，我们进行了一项荟萃分析，以比较IB期患者辅助化疗与单纯手术的疗效。检索了六个电子数据库以查找相关文章。主要和次要结局为总生存期（OS）和无病生存期（DFS）。使用对数秩检验，通过风险比比较至事件发生时间结局。确定了16项合格试验。共纳入4656例患者，分为2组：化疗组2338例，对照组2318例（仅手术）。患者接受以铂为基础的治疗、尿嘧啶-替加氟或两者联合治疗。我们的结果表明，患者可以从辅助化疗中获益，OS（HR 0.74 95% CI 0.63-0.88）和DFS（HR 0.64 95% CI 0.46-0.89）。接受6个周期铂类药物治疗的患者（HR 0.45 95% CI 0.29-0.69），尿嘧啶-替加氟（HR 0.71 95% CI 0.56-0.90），或两者的组合（HR 0.51 95% CI 0.36-0.74）的患者有更好的OS，但接受4个或更少周期铂类药物治疗的患者（HR 0.97 95% CI 0.85-1.11）没有更好的OS。单用6周期铂类药物治疗（HR 0.29 95% CI 0.13-0.63）或联合尿嘧啶-替加氟（HR 0.44 95% CI 0.30-0.66）治疗DFS具有优势。然而，4个或更少周期的铂类药物治疗（HR 0.89 95% CI 0.76-1.04）或尿嘧啶-替加氟单药治疗（HR 1.19 95% CI 0.79-1.80）均无获益。6周期铂类化疗可改善IB期NSCLC患者的OS和DFS。尿嘧啶-替加氟单用或与铂类药物联合治疗对患者的OS有益，但尿嘧啶-替加氟似乎在延长DFS方面没有优势，除非与铂类药物联合治疗。
Supplemental Digital Content is available in the text Adjuvant chemotherapy is recommended for postoperative stage II-IIIB nonsmall cell lung cancer patients. However, its effect remains controversial in stage IB patients. We, therefore, performed a meta-analysis to compare the efficacy of adjuvant chemotherapy versus surgery alone in stage IB patients. Six electronic databases were searched for relevant articles. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS). The time-to-event outcomes were compared by hazard ratio using log-rank test. Sixteen eligible trials were identified. A total of 4656 patients were included and divided into 2 groups: 2338 in the chemotherapy group and 2318 in the control group (surgery only). Patients received platinum-based therapy, uracil-tegafur, or a combination of them. Our results demonstrated that patients can benefit from the adjuvant chemotherapy in terms of OS (HR 0.74 95% CI 0.63–0.88) and DFS (HR 0.64 95% CI 0.46–0.89). Patients who received 6-cycle platinum-based therapy (HR 0.45 95% CI 0.29–0.69), uracil-tegafur (HR 0.71 95% CI 0.56–0.90), or a combination of them (HR 0.51 95% CI 0.36–0.74) had better OS, but patients who received 4 or fewer cycles platinum-based therapy (HR 0.97 95% CI 0.85–1.11) did not. Moreover, 6-cycle platinum-based therapy (HR 0.29 95% CI 0.13–0.63) alone or in combination with uracil-tegafur (HR 0.44 95% CI 0.30–0.66) had advantages in DFS. However, 4 or fewer cycles of platinum-based therapy (HR 0.89 95% CI 0.76–1.04) or uracil-tegafur alone (HR 1.19 95% CI 0.79–1.80) were not beneficial. Six-cycle platinum-based chemotherapy can improve OS and DFS in stage IB NSCLC patients. Uracil-tegafur alone or in combination with platinum-based therapy is beneficial to the patients in terms of OS, but uracil-tegafur seems to have no advantage in prolonging DFS, unless it is administered with platinum-based therapy.