预防性颅脑照射对非小细胞肺癌疗效和不良反应的meta分析

doi:10.3760/cma.j.cn113030-20211122-00480

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摘要目的通过meta分析探讨预防性颅脑照射（PCI）在非小细胞肺癌（NSCLC）中的作用。方法系统检索PubMed、Embase、Cochrane系统评论数据库和中国国家知识基础设施数据库1980年1月1日至2021年8月30日发表的研究。搜索词有“非小细胞肺癌”“随机对照试验”“预防性头颅照射”和“临床试验”。从上述研究中提取的研究数据采用Review Manager 5.3和Stata 12.0软件进行分析。结果包括脑转移（BM）的发展、总生存（OS）期、无瘤生存（DFS）期、不良反应、生活质量（QoL）。结果包含2005例NSCLC患者的10项试验符合纳入标准。与未接受PCI的患者相比,接受PCI的患者发生BM的风险显著降低（OR=0.29,95%CI为0.22~0.40,P<0.001）。与非PCI组相比,PCI组的DFS期显著延长（HR=0.75,95%CI为0.63~0.89,P=0.001）,然而OS的差异无统计学意义（OR=0.90,95%CI为0.69~1.18,P=0.45）。此外,PCI组的疲劳明显增加（OR=2.64,95%CI为1.58~4.40,P<0.001）。PCI组与非PCI组认知障碍差异无统计学意义（OR=3.60,95%CI为0.97~13.32,P=0.06）。结论对于NSCLC,实施PCI作为患者的标准治疗方案,与非PCI相比,PCI明显降低了NSCLC的BM发生率,延长了DFS期,而PCI相关不良反应对QoL以及长期OS的影响则需要进一步研究。

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	黄圣凯
	张慧亮
	冯楠

关键词 ：脑转移瘤, 无瘤生存, 癌,非小细胞肺, 总生存, 预防性颅脑照射, 生活质量, 不良反应

Abstract：Objective To investigate the role of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) by meta-analysis. Methods Studies published from January 1, 1980 to August 30, 2021 were searched systematically in PubMed, Embase, Cochrane Systematic Review database and China National Knowledge Infrastructure Database. The searching keywords included "non-small cell lung cancer", "randomized controlled trial", "prophylactic cranial irradiation" and "clinical trial". The data extracted from the above studies were analyzed using Review Manager 5.3 and Stata 12.0 software. Outcomes included the development of brain metastases (BM), overall survival (OS), disease-free survival (DFS), toxicity, and quality of life (QoL). Results Ten trials, including 2005 NSCLC patients, met the inclusion criteria. Patients who underwent PCI had a significantly lower risk of BM than those who did not (OR=0.29, 95%CI: 0.22-0.40, P<0.001). Compared with non-PCI group, DFS in PCI group was significantly increased (HR=0.75, 95%CI: 0.63-0.89, P=0.001). However, there was no significant difference in OS (OR=0.90, 95%CI: 0.69-1.18, P=0.45). In addition, the incidence of fatigue was significantly increased in the PCI group (OR=2.64, 95%CI: 1.58-4.40, P<0.001). There was no significant difference in cognitive impairment between the PCI and non-PCI groups (OR=3.60, 95%CI: 0.97-13.32, P=0.06). Conclusions PCI is the standard treatment for NSCLC. Compared with non-PCI, PCI significantly reduces the incidence of BM and prolongs the DFS of NSCLC patients. The effect of PCI-related toxicity on the QoL and long-term OS needs further study.

Key words： Brain metastases Disease-free survival Carcinoma,non-small cell lung Overall survival Prophylactic cranial irradiation Quality of life Toxicity

收稿日期: 2021-11-22

通讯作者: 冯楠,Email：feng971123@163.com

引用本文:

黄圣凯,张慧亮,冯楠. 预防性颅脑照射对非小细胞肺癌疗效和不良反应的meta分析[J]. 中华放射肿瘤学杂志, 2023, 32(2): 118-123.

Huang Shengkai,Zhang Huiliang,Feng Nan. Clinical efficacy and toxic effects of prophylactic cranial irradiation in non-small cell lung cancer: a meta-analysis[J]. Chinese Journal of Radiation Oncology, 2023, 32(2): 118-123.

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