Objective To evaluate the effectiveness and safety of nedaplatin combined with chemotherapy versus cisplatin combined with chemotherapy for advanced non-small cell lung cancer (NSCLC). Methods The randomized controlled trials (RCTs) on nedaplatin combined with chemotherapy versus cisplatin combined with chemotherapy for advanced NSCLC were searched in The Cochrane Library, PubMed, EMbase, CBM, VIP and WanFang Data from the date of their establishment to January 2012. According to the inclusion and exclusion criteria, two reviewers independently screened the studies, extracted the data and assessed the quality. Then RevMan 5.0 software was used for meta-analysis. Results A total of 15 RCTs involving 1 076 patients were included. The results of meta-analysis showed that, compared with the cisplatin combined with chemotherapy, nedaplatin combined with chemotherapy could reduce the risks of nausea and vomiting (RR=0.56, 95%CI 0.48 to 0.65, Plt;0.000 01), decrease the risk of renal function impairment (RR=0.47, 95%CI 0.30 to 0.74, P=0.001), but increase the risk of thrombocytopenia (RR=1.59, 95%CI 1.20 to 2.11, P=0.001). There were no significant differences between the two groups in objective response rate (ORR) (RR=1.09, 95%CI 0.92 to 1.29, P=0.03), leukopenia (RR=1.05, 95%CI 0.92 to 1.19, P=0.50), and hemoglobin reduction (RR=0.92, 95%CI 0.80 to 1.07, P=0.30). Conclusion Compared with cisplatin combined with chemotherapy for advanced NSCLC patients, nedaplatin in combination with chemotherapy can significantly reduce the risks of nausea, vomiting and renal function impairment. Although the ORRs are similar in the two groups, nedaplatin combined with chemotherapy can cause a higher risk of thrombocytopenia. For the quality restriction and possible publication bias of the included studies, more high quality RCTs are required to further verify this conclusion.
Objective To analyze and screen the risk factors of both immunohistochemistry and pathology for lung cancer lymphatic metastasis, and to build a mathematical model for preliminary evaluation. Methods By conducting retrospective studies, the information of lung cancer patients in the General Hospital of Air Force from 2009 to 2011 were collected. Both single and multiple unconditional logistic regression analyses were applied to screen total 27 possible factors for lymphatic metastasis. After the factors with statistical significance were selected, the relevant mathematical model was built and then evaluated by means of receiver operating characteristic (ROC) analysis. Results A total of 216 patients were included. The single analyses on 27 possible factors showed significant differences in the following 10 factors: pathological grade (P=0.00), age (P=0.00), tumor types (P=0.01), nm23 (P=0.00), GSTII (P=0.01), TTF1 (P=0.01), MRP (P=0.01), CK14 (P=0.02), CD56 (P=0.02), and EGFR (P=0.03). The multiple factors unconditional logistic regression analyses on those 10 risk factors screened 4 relevant factors as follows: pathological grade (OR=2.34), age (OR=1.02), nm23 (OR=1.66), and EGFR (OR=1.47). Then a mathematical diagnostic model was established based on those 4 identified risk factors, and the result of ROC analysis showed it could improve the diagnostic sensitivity and specificity compared with the single factor mathematical diagnostic model. Conclusion Pathological grade, age, nm23, and EGFR are related with lung cancer lymphatic metastasis, and all of them are the risk factors which have higher adjuvant diagnostic value for lung cancer lymphatic metastasis.
ObjectiveTo analyze the surgical techniques and perioperative patient management of bronchial sleeve resection and plasty, carinal resection and reconstruction, and angioplasty in the treatment of locally advanced central type of lung cancer and summarize the experiences. MethodsWe retrospectively analyzed the clinical data of 21 locally advanced central type of lung cancer patients with bronchial sleeve resection and plasty, carinal resection and reconstruction, and angioplast in our hospital from December 2011 through November 2014. There were 17 males and 3 females with a mean age of 63.2±6.2 years. All operations were successful. The time of operation was 3.29±0.75 h. The hospitalization time was 25.48±22.31 days. No death ocurred during perioperative period. Postoperative complications were found in 3 patients, including 2 patients with atelectasis and 1 patient with bronchopleural fistula. ConclusionBronchial sleeve resection and plasty, carinal resection and reconstruction, and angioplasty apply to treat locally advanced central type of lung cancer not only maximally remove the lung cancer tissue, but also maximally reserve the healthy lung tissue.
The resistance of non-small cell lung cancer (NSCLC) to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has been brought into focus. COX-2 signal pathway was found to be closely related to EGFR signal pathway by recent researches, and there has been a growing interest to focus the researches on whether COX-2 pathway inhibition improves the efficacy of EGFR-TKIs in treating advanced NSCLC. In this review, we will illustrate recent advances of combined inhibition of EGFR and COX-2 signal pathways in NSCLC therapy.
Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
Objective Through the analysis of hospital costs of 16 866 cases of patients with lung cancer in Sichuan Province, in oder to find the main influencing factors of hospital costs of patients with lung cancer, and to provide references for reducing the hospital costs of patients with lung cancer. Methods We selected information of in-patients with lung cancer in 6 hospitals in Sichuan province from January 2008 to December 2011 based on full consideration into the local economic levels geographics distribution of different regions in Sichuan province. Then we extracted baseline data, hospitalization data and costs, and then analysis on relevant influencing factors was performed using single factor analysis of variance and multiple stepwise regression analysis. Results A total of 16 918 cases are chosen, of which, 16 866 were effective for further analysis. The results of statistical analysis showed that, the cost of western medicine accounted for the most of the average of the total hospital costs (50.79%) , followed by the cost of diagnosis and treatment (40.79%). The reuslts of multiple stepwise regression analysis showed that, the top three factors influencing hospital costs most included hospital stay, operation, and regions. Conclusion Facing daily increasing costs of hospital costs of lung cancer, effectively reducing drug expenses of patients could be a breakthrough. We could ultimately reduce the hospital costs of patients with lung cancer as well as the the economic burden of patients and society, by strengthening hospital management, shortening hospital stay, and rationally regulating drug use.
Objective To systematically review the effectiveness and safety of erlotinib for the elderly with Non-small-cell lung cancer (NSCLC). Methods Databases including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI and WanFang Data were electronically searched for relevant randomized controlled trails (RCTs). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally 5 studies were included. The results of meta-analysis showed that, the objective response rate and stable disease rate was similar between the erlotinib group and the control group with no significant difference (RR=0.99, 95%CI 0.34 to 2.93, P=0.99; RR=1.17, 95%CI 0.95 to 1.43, P=0.14). The incidences of Grade Ⅲ-Ⅳ neutropenia and thrombocytopenia were lower in the erlotinib group than those in the control group (OR=0.12, 95%CI 0.03 to 0.52, P=0.005; OR=0.19, 95%CI 0.04 to 0.91, P=0.04); and the incidences of nausea and vomiting as wel as liver impairments were alike between the two groups (OR=0.93, 95%CI 0.12 to 7.08, P=0.95; OR=0.80, 95%CI 0.24 to 2.68, P=0.71); the incidences of diarrhea and skin rashes in the erlotinib group were higher (OR=5.96, 95%CI 1.28 to 27.88, P=0.02; OR=6.77, 95%CI 1.52 to 30.10, P=0.01). Conclusion Current evidence shows that, erlotinib is effective and safe in treating the elderly with NSCLC with better effects and no serious adverse reaction. However, due to the limited quantity and quality of the included studies, more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclusion.
Objective To evaluate the association between the Thr241Met polymorphism in the XRCC3 gene and the risk of lung cancer in Chinese population by meta-analysis. Methods Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were searched to identify domestic and foreign case-control studies concerning the association between Thr241Met polymorphism in XRCC3 gene and the risk of lung cancer in Chinese population from the inception to August 20th, 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data and assessed quality. Then meta-analysis was performed using RevMan 5.0 software and Stata 10.0 software. Results A total of 5 case-control studies involved 2 999 lung cancer cases and 2 994 controls were included. The results of meta-analysis showed that, Chinese population who carry the variant genotype or allele had no increased risk of lung cancer: Met/Met vs. Thr/Thr: OR=1.00, 95%CI (0.38, 2.59), P=0.99; Met/Met vs. Thr/Met: OR=1.06, 95%CI (0.83, 1.36), P=0.63; Met/Met vs. Thr/Met+Thr/Thr: OR=0.99, 95%CI (0.38, 2.57), P=0.98; Thr/Met+Met/Met vs. Thr/Thr: OR=1.06, 95%CI (0.82, 1.37), P=0.65; Met vs. Thr: OR=1.05, 95%CI (0.82, 1.35), P=0.68. Conclusion Currently, Thr241Met polymorphism in the XRCC3 gene is not found to be associated with the risk of lung cancer in Chinese population. Considering the limited quality of the included case-control studies, more high quality studies with large sample size are needed to verify the above conclusion.
Objective To assess the effectiveness and safety of high-dose chemotherapy assisted with autologous peripheral blood stem cell treatment (APBSCT+HDC) for small cell lung cancer (SCLC). Methods The databases such as MEDLINE (1970 to January 2011), EMBASE (1980 to January 2011), Science Direct (1980 to January 2011), The Cochrane Library (Issue 3, 2010), CNKI (from the date of establishment to December 2010), CBM (from the date of establishment to December 2010) and Wanfang database (from the date of establishment to December 2010) were searched for collecting randomized controlled trials (RCTs) on APBSCT+HDC for SCLC. According to the inclusive and exclusive criteria, the trials were screened, the data were extracted, the methodological quality was assessed, and then Meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 737 patients with SCLC were included. The results of Meta-analyses were as follows: the APBSCT+HDC for SCLC was significantly superior to the conventional chemotherapy in the total effective rate (RR=1.14, 95%CI 1.07 to 1.21, Plt;0.000 1) and the overall survival rate (RR=3.74, 95%CI 2.13 to 6.58, Plt;0.000 01), and it was superior in reducing the incidence of III/IV grade red blood cell reduction (RR=1.97, 95%CI 1.15 to 3.38, P=0.01) and thrombopenia (RR=1.93, 95%CI 1.06 to 3.54, P=0.03) with significant differences; but there was no significant difference between the two groups in reducing the incidence of III/IV leukopenia. Conclusions Compared with the conventional chemotherapy, APBSCT+HDC treatment for SCLC can improve the overall effective rate and overall survival rate, but it can also increase the risks of severe hematologic toxic reaction. Because of the small scale and low quality of the included studies, this conclusion still needs to be confirmed by high-quality, large-scale and multi-centered RCTs.
Objective To make an individulized treatment plan for a patient with locally advanced non-small cell lung cancer (NSCLC). Methods After clinical problems were put forward, evidence was collected from http://www. nccn.org. The Cochrane Library (Issue 4, 2008), Medline (PubMed 1990. 1-2008.11) and CHKD periodical database were searched. Results A total of 21 RCTs, 5 systematic reviews and 13 CT phase Ⅲ trials were identified. A rational treatment plan was made upon a serious evaluation of the data. After nine monthes of follow-up, the plan was proved optimal. Conclusion For locally advanced NSCLC patients, an individulized treatment plan made by evidence-based methods not only can inprove the treatment efficacy but also can lead both of doctors and patients to assume the indeterminateness of medicine.