顺铂联合方案胸腔灌注治疗肺癌合并恶性胸腔积液的短期疗效及安全性的网状Meta分析

马丽; 吴勇; 曾永蕾

文章摘要

马丽，吴勇，曾永蕾.顺铂联合方案胸腔灌注治疗肺癌合并恶性胸腔积液的短期疗效及安全性的网状Meta分析[J].实用中西医结合临床,2023,23(4):1-8

顺铂联合方案胸腔灌注治疗肺癌合并恶性胸腔积液的短期疗效及安全性的网状Meta分析

Short-Term Efficacy and Safety of Cisplatin Combined with Pleural Perfusion in the Treatment of Lung Cancer with Malignant Pleural Effusion： A Mesh Meta Analysis*

DOI：

中文关键词: 肺癌恶性胸腔积液灌注治疗顺铂网状Meta分析

英文关键词: Lung cancer Malignant pleural effusion Perfusion therapy Cisplatin Meta reticular analysis

基金项目:曾永蕾安徽省名医工作室[编号：（2020）10号]；安徽省中医药传承创新项目（编号：2020ccyb05）

作者	单位
马丽，吴勇，曾永蕾	安徽中医药大学第二附属医院肿瘤科

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中文摘要:

目的：基于网状Meta分析方法，比较目前常用的不同顺铂联合方案胸腔灌注治疗肺癌合并恶性胸腔积液短期的有效性及安全性，评选出较优的方案供临床参考。方法：通过PubMed、Embase、Cochrane、CNKI、VIP、WanFang、CBM等数据库检索有关顺铂联合方案胸腔灌注治疗肺癌合并恶性胸腔积液的随机对照试验（RCT）。运用Stata15.0软件进行统计学分析，以OR值及95%可信区间为效应指标，比较各顺铂联合方案的疗效及不良反应发生率，并进行排序。结果：经筛选后最终纳入31项RCT，合计2 350例肺癌合并恶性胸腔积液患者，共涉及7种顺铂联合方案。网状Meta分析结果显示：临床总疗效方面，7种顺铂联合灌注方案与单纯顺铂灌注治疗比较，差异均有统计学意义（P＜0.05），排序结果为：顺铂+重组改构人肿瘤坏死因子（rmh-TNF）＞顺铂+洛铂＞顺铂+榄香烯＞顺铂+恩度＞顺铂+香菇多糖＞顺铂+白细胞介素-2＞顺铂+贝伐珠单抗；消化道不良反应发生率方面，涉及6种不同顺铂联合方案，仅顺铂联合榄香烯方案较单纯顺铂灌注治疗发生率低，差异有统计学意义（P＜0.05），发生率从低到高的排序为：顺铂+榄香烯＞顺铂+贝伐单抗＞顺铂+rmh-TNF＞顺铂+香菇多糖＞顺铂+恩度＞单纯顺铂灌注＞顺铂+白细胞介素-2；骨髓抑制发生率方面，涉及5种不同顺铂联合方案，仅顺铂联合榄香烯方案较单纯顺铂灌注治疗发生率低，差异有统计学意义（P＜0.05），发生率从低到高的排序为：顺铂+榄香烯＞顺铂+贝伐单抗＞顺铂+香菇多糖＞顺铂+恩度＞顺铂+白细胞介素-2＞单纯顺铂灌注。结论：顺铂联合rmh-TNF胸腔灌注治疗肺癌合并恶性胸腔积液在短期疗效上占明显优势，综合总有效率及安全性考虑，顺铂联合榄香烯灌注治疗可能是最佳方案，仍需多中心大样本的RCT加以验证。

英文摘要:

Objective: To compare the short-term efficacy and safety of different cisplatin combined regimen in the treatment of lung cancer with malignant pleural effusion based on reticular meta analysis and to select a better scheme for clinical reference. Methods: A randomized controlled trial (RCT) of cisplatin combined with pleural perfusion for lung cancer complicated with malignant pleural effusion was retrieved by PubMed, Embase, Cochrane, CNKI, VIP, WanFang, CBM database (RCT). Using Stata15.0 software for statistical analysis, the effects of OR value and 95% confidence interval were compared incidence of adverse reactions, and sort. Results: 31 RCT were selected total 2 350 cases of lung cancer with malignant pleural effusion, a total of 7 cisplatin combinations were involved. And the results of reticularmeta analysis showed that, there were statistically significant differences between the 7 cisplatin combination infusion schemes and simple cisplatin infusion therapy (P＜0.05). The sorting results were as follows: cisplatin + rmh-TNF＞cisplatin + loplatin＞cisplatin + elemene＞cisplatin + endu＞cisplatin + lentinan＞cisplatin + interleukin-2＞cisplatin + bevacizumab. The incidence of gastrointestinal reactions, six different combinations of cisplatin. In terms of the incidence of gastrointestinal adverse reactions, 6 different cisplatin combined regimenwere involved, and only cisplatin combined elemene regimen had a lower incidence than simple cisplatin infusion therapy, with statistical significance (P＜0.05). Ranking the incidence from lowest to highest: cisplatin + elemene＞cisplatin + bevacizumab＞cisplatin + lentinus polysaccharide＞cisplatin + endu＞simple cisplatin perfusion＞cisplatin + interleukin-2. The incidence of bone marrow suppression involved 5 different cisplatin combinations. The incidence of cisplatin combined elemene only was lower than that of pure cisplatin infusion, and the difference was statistically significant (P＜0.05). Ranking the incidence from lowest to highest: cisplatin + elemene＞cisplatin + bevacizumab＞cisplatin + lentinan＞cisplatin + endu＞cisplatin + interleukin-2＞simple cisplatin perfusion. Conclusion: Cisplatin combined with rmh-TNF pleural perfusion in the treatment of lung cancer with malignant pleural effusion has obvious advantages in the short term. Considering the comprehensive efficiency and safety, cisplatin combined with elemene may be the best treatment. Still need to multi-center RCT of large sample verification.

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