Background: Advanced non-small cell lung cancer (NSCLC) is characterized by poor treatment efficacy and short survival time. Clinical trials have shown that the combination of chemotherapy with thermotherapy exhibits strong efficacy. We performed this meta-analysis to evaluate the clinical efficacy and safety of gemcitabine plus cisplatin (GP) and paclitaxel plus cisplatin (TP) combined with thermotherapy in the treatment of NSCLC, as well as to provide reference for clinical practice and future research.
Methods: We searched international (Cochrane Library, PubMed, and EMBASE) and Chinese (CBM, CNKI, VIP and Wanfang) databases for relevant articles and imported other retrievable sources, such as tracing-related references. We also corresponded with other authors to obtain certain inaccessible information. Data from all relevant randomized controlled trials (RCT) were collected to compare GP or TP thermochemotherapy with GP or TP chemotherapy alone. The quality of the included studies was assessed by adequate outcome-based standards and clinical circumstances. The meta-analysis was conducted using RevMan 5.1.
Results: Fifteen RCTs involving 952 patients were included in this meta-analysis. The results showed that the thermochemotherapy group had higher rates of improvement in quality of life (OR=3.84, 95%CI: 2.61-5.64), survival at 1 year (HR=1.94, 95%CI: 1.21-3.12), and survival at 2 years (HR=2.05, 95%CI: 1.18-3.58) compared with the chemotherapy group, with the differences between them being significant. However, these groups did not differ in other indicators of treatment effectiveness, such as myelosuppression, alimentary canal reactions, hepatic lesions, and diarrhea.
Conclusions: Compared with chemotherapy alone, thermochemotherapy can improve survival rates and curative effects, ameliorate symptoms, and enhance the quality of life of patients with advanced NSCLC, and it has an acceptable safety profile. The results of this meta-analysis warrant further investigation with a larger sample size and using a high-quality RCT design.
背景与目的: 中晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）的治疗效果较差，生存期也较短，临床研究显示化疗与热疗的联合疗法效果较好。本研究通过系统评价吉西他滨联合铂类（Gemcitabine and Cisplatin, GP）或紫杉醇联合铂类（Paclitaxel and Cisplatin, TP）方案化疗联合热疗治疗NSCLC的疗效及安全性，为临床实践与研究提供参考。
方法: 计算机检索Cochrane Library、PubMed、EMBASE和中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库、数字化期刊全文数据库，同时辅以其它检索。收集所有比较GP或TP化疗联合热疗与单纯GP或TP化疗的随机对照试验（randomized controlled trial, RCT）。选择适当的质量评价标准对纳入文献进行质量评价，使用RevMan 5.1软件进行meta分析。
结果: 共纳入15篇RCT，共952例NSCLC。Meta分析结果显示，化疗联合热疗组的生活质量改善率（OR=3.84, 95%CI: 2.61-5.64）、1年生存率（HR=1.94, 95%CI: 1.21-3.12）和2年生存率（HR=2.05, 95%CI: 1.18-3.58）均好于单纯化疗组，差异均有统计学意义（P < 0.05）；热化组与单化组的骨髓抑制、胃肠反应、肝肾损害以及腹泻发生率的差异均无统计学意义（P > 0.05）。
结论: 相较于单纯化疗，GP或TP方案化疗联合热疗能提高中晚期NSCLC患者生存率和近期疗效，改善症状，提高患者的生活质量，且并不增加毒副反应，但本文结论尚需大样本高质量RCT进一步验证。