摘要
目的系统评价胸腔化疗联合热疗治疗癌性胸腔积液的有效性及安全性。方法 2015年8月—2016年1月,计算机检索Cochrane Library、PubMed、EMBase、Web of Science等外文数据库以及中国生物医学文献数据库、中国知网、维普网和万方数据知识服务平台等中文数据库,并辅以补充检索手段,收集比较胸腔化疗联合热疗(联合组)与单纯胸腔化疗(对照组)治疗癌性胸腔积液有效性及安全性的随机对照试验。提取纳入文献资料,包括第一作者、发表时间、样本量、年龄、卡氏评分、化疗方案及结局指标,并进行方法学质量评价。结果共纳入23篇文献,包括1 647例患者,其中联合组819例,对照组828例。5篇文献报道了随机方法,各纳入文献均未说明分配隐藏和盲法实施情况,各文献两组患者基本特征具有可比性,1篇文献有患者失访,各文献均无选择性报告结果偏倚。联合组治疗癌性胸腔积液总有效率[OR=3.72,95%CI(2.92,4.74)]、完全缓解率[OR=2.24,95%CI(1.18,2.78)]、生活质量改善率[OR=3.66,95%CI(2.64,5.07)]均高于对照组(P<0.05)。联合组与对照组恶心呕吐[OR=0.80,95%CI(0.60,1.06)]、白细胞计数下降[OR=0.81,95%CI(0.60,1.10)]、发热[OR=0.98,95%CI(0.69,1.40)]、肝脏损害[OR=0.45,95%CI(0.11,1.81)]、气胸[OR=0.41,95%CI(0.06,2.91)]、皮肤烫伤[OR=5.33,95%CI(0.91,31.14)]发生率比较,差异均无统计学意义(P>0.05);联合组胸痛[OR=0.34,95%CI(0.16,0.74)]发生率低于对照组,皮下脂肪硬结[OR=6.27,95%CI(1.08,36.27)]发生率高于对照组(P<0.05)。结论与单纯胸腔化疗相比,胸腔化疗联合热疗可提高癌性胸腔积液患者近期疗效,显著改善患者生活质量,并且临床安全性较好,但其长期疗效和安全性评价尚需大样本高质量的研究进一步验证。
Objective To systematically review the efficacy and safety of intrathoracic chemotherapy combined with thermotherapy（ ITCT） for malignant pleural effusion（ MPE）. Methods From August 2015 to January 2016,a computer-based retrieval was performed in foreign databases such as Cochrane Library,PubMed,EMBase,Web of Science and Chinese ones such as CBM,CNKI,VIP and Wanfang,and supplementary retrieval was also performed with other sources. All relevant randomized controlled trials（ RCTs） were collected to compare ITCT（ ITCT group） and monotherapy of intrathoracic chemotherapy（ ITC group）. We extracted the relevant information from the literatures,including the first author,published time,sample size,age,Karnofsky performance status,chemotherapy regimens and outcome indicators. Then we assessed the methodologic quality of included studies. Results A total of 23 literatures were included,comprising 1 647 patients,including819 in the ITCT group and 828 in the ITC group. Five studies reported random methods, yet none of the included studies mentioned the concealment of allocation and blinding. The baseline comparability of the two groups had fine balance. One study had loss of follow-up. There was no selective outcome reporting in any of the included studies. Total effective rate [OR= 3. 72,95% CI（ 2. 92,4. 74） ],complete remission rate [OR = 2. 24,95% CI（ 1. 81,2. 78） ]and improving rate of life quality [OR = 3. 66,95% CI（ 2. 64,5. 07） ]of ITCT group were superior to those of ITC group and there were all significant difference（ P〈0. 05）. There were no significant difference between the two groups on the incidence of nausea and vomiting[OR= 0. 80,95% CI（ 0. 60,1. 06） ], leukocytopenia [OR = 0. 81,95% CI（ 0. 60,1. 10） ], fever [OR = 0. 98,95% CI（ 0. 69,1. 40） ],hepatic lesion [OR = 0. 45,95% CI（ 0. 11,1. 81） ],pneumothorax [OR = 0. 41,95% CI（ 0. 06,2. 91） ]and skin scald[OR = 5. 33,95% CI（ 0. 91,31. 14） ]. The incidence of stethalgia in ITCT group was lower than ITC group[OR = 0. 34,95% CI（ 0. 16,0. 74） ],the incidence of subcutaneous fat scleroma in ITCT group was higher than ITC group[OR = 6. 27,95% CI（ 1. 08,36. 27） ],and there were all significant difference（ P〈0. 05）. Conclusion Compared with ITC,ITCT can significant improve short-term curative effect and life quality of patients with MPE; additionally,it is safe and feasible. But its long-term survival rate and security still needs to be further verified by more large sample and high quality studies.
出处
《中国全科医学》
CAS
北大核心
2017年第32期4034-4041,共8页
Chinese General Practice
关键词
胸腔积液
恶性
化学疗法
肿瘤
热疗
疗效
META分析
malignant pleural effusion（ MPE）
ITCT（ ITCT group）
monotherapy of intrathoracic chemotherapy（ ITC group）
concealment
allocation
blinding
