新辅助化疗对Ⅲ期非小细胞肺癌远期生存率影响循证医学探究.doc

新辅助化疗对Ⅲ期非小细胞肺癌远期生存率影响循证医学探究 　【摘要】 目的 探讨新辅助化疗对Ⅲ期非小细胞肺癌患者远期生存率的影响。方法 用循证医学的方法复习国内外文献，收集相关研究资料。根据获得的文献数据，分别对新辅助化疗和单纯手术治疗两种疗法的1年、3年和5年生存率情况进行Meta分析。结果 共检索出符合条件的国内外文献12篇。Meta分析显示两组间1年及3年生存率差异无显著性，而5年生存率差异有显著性。单独分析国内资料显示两组5年生存率差异无显著性。结论 尚不能确定两种治疗方式对Ⅲ期NSCLC患者远期生存率的影响，还需要进行多中心，更大样本量的前瞻性随机对照研究。 【关键词】 非小细胞肺癌；循证医学；Meta分析；新辅助化疗；生存率；前瞻性研究 Evidence based medical research of neoadjuvant chemotherapy on long-term survival rate of III stage non-small cell lung cancer 【Abstract】 Objective To study the influence of neoadjuvant chemotherapy to long-term survival rate of III stage non-small cell lung cancer (NSCLC).Methods Domestic and overseas literatures were reviewed with evidence based medical research method. Correlative research data were collected. 1, 3 and 5 years survival rates of neoadjuvant chemotherapy group and surgery alone group were meta analyzed according the acquired data. Results Total 12 domestic and overseas literatures consistent with the conditions were detected. Meta-analysis results indicated that 1 and 3 years survival rates were not significantly different but 5 years survival rates were significantly different between the two groups. However, 5 years survival rates were not significantly different between the two groups when the domestic literatures were meta analyzed alone. Conclusion The influences of neoadjuvant chemotherapy and surgery alone to long-term survival rates of III stage NSCLC patients were still not definite. We still need more multicenter and large sample prospective random control studies. 【Key words】 non-small cell lung cancer; evidence based medicine; meta analysis;neoadjuvant chemotherapy; survival rate;prospective study 非小细胞肺癌的手术多学科治疗中化疗占重要地位，可分为新辅助化疗和辅助化疗［1］。新辅助治疗主要对象为局限性广泛期患者。辅助化疗的目的在于减少术后复发转移，但1995年Meta分析显示辅助化疗无益于生存率［2］，然而在2003、2004年ASCO会议上Le Chevalier、Winton、Strauss［3～5］报告的3项大样本随机研究提示辅助化疗有助于提高NSCLC的生存率。本研究通过循证医学方法，通过复习文献，对Ⅲ期NSCLC的新辅助化疗对患者远期生存影响进行分析。 1 材料与方法 1.1 复习国内外文献，收集相关研究资料。 1.1.1 外文文献 检索工具采用在线PubMed，网络地址：检索时间不限制，外文检索策略见表1