胸腔热灌注化疗治疗肺癌恶性胸腔积液临床疗效的Meta分析

A Meta-Analysis of the Clinical Efficacy of Hyperthermic Intrathoracic Chemotherapy in the Treatment of Malignant Pleural Effusion Caused by Lung Cancer

摘要: 目的：探讨胸腔热灌注化疗治疗肺癌恶性胸腔积液的临床疗效及安全性。方法：计算机检索PubMed、中国期刊全文数据库(CNKI)、万方数据库、维普数据库(VIP)，收集有关胸腔热灌注化疗与胸腔灌注化疗治疗恶性胸腔积液的随机对照研究，主要结局指标包括客观缓解率、疾病控制率、生活质量改善率、骨髓抑制、消化道反应、肝肾功能损伤、胸痛，使用固定效应模型或随机效应模型计算具有95%置信区间的风险比和标准化均数差，用Stata 14.0和RevMan 5.3软件进行Meta分析。结果：纳入10项研究共780例患者，其中实验组407例，对照组373例。综合分析显示：实验组客观缓解率、疾病控制率及生活质量改善率(RR = 1.39, 95% CI: 1.27~1.53, P < 0.00001; RR = 1.12, 95% CI: 1.07~1.18, P < 0.00001; SMD = 1.44, 95% CI: 0.31~2.57, P = 0.013)明显高于对照组，且差异均具有统计学意义。在安全性方面，两组骨髓抑制、消化道反应、肝肾功能损伤、胸痛方面，差异均无统计学意义(均P > 0.05)。结论：胸腔热灌注化疗治疗肺癌引起的恶性胸腔积液，能提高总有效率，改善患者生活质量，具有良好的安全性。

Abstract: Objective: To investigate the clinical efficacy and safety of hyperthermic intrathoracic chemothera-py in the treatment of malignant pleural effusion of lung cancer. Methods: PubMed, CNKI, Wanfang and VIP database were searched by computer to collect randomized controlled studies on the treatment of malignant pleural effusion by hyperthermic intrathoracic chemotherapy and pleural infusion chemotherapy. Primary outcome measures included objective response rate, disease con-trol rate, quality of life improvement rate, myelosuppression, digestive tract reaction, liver and kidney function impairment, and chest pain. Hazard ratios with 95% confidence intervals and standardized mean difference were calculated using fixed effects model or random effects model. Meta-analysis was performed using Stata 14.0 and RevMan 5.3 software. Results: A total of 780 pa-tients were included in 10 studies, including 407 patients in the experimental group and 373 pa-tients in the control group. Comprehensive analysis showed that objective remission rate, disease control rate and quality of life improvement rate in the experimental group (RR = 1.39, 95% CI: 1.27~1.53, P < 0.00001; RR = 1.12, 95% CI: 1.07~1.18, P < 0.00001; SMD = 1.44, 95% CI: 0.31~2.57, P = 0.013) were significantly higher than the control group, and the differences were statistically significant. In terms of safety, there were no significant differences in bone marrow suppression, digestive tract reaction, liver and kidney function injury and chest pain between the two groups (P > 0.05). Conclusion: Hyperthermic intrathoracic chemotherapy in the treatment of malignant pleural effusion caused by lung cancer can improve the total effective rate, improve the quality of life of pa-tients, and has good safety.