| [Background]:Lung cancer is one of the highest incidence and mortality of malignant tumor in the world, newly diagnosed each year about1.4million cases, about120million cases died annually. Small cell lung cancer (SCLC) accounts for about20%of lung cancer patients, chemotherapy is the main treatment, for its fast growth, highly aggressive and chemotherapy-sensitive biological characteristics. But the remission time not lasting of conventional dose chemotherapy (median remission more than6to8months), and up to95%patients will die as a result of disease recurrence or metastasis. There are many clinical studies about the peripheral blood stem cell support in high-dose chemotherapy (APBSCT+HDC) treatment of SCLC, but the efficacy and safety remains controversial.[Objective] To assess the effectiveness and safety of high-dose chemotherapy assisted with autologous peripheral blood stem cell treated the small cell lung cancer.[Method] We searched MEDLINE (1970-2012.1), EMBASE (1980-2012.1), ScienceDirect (1980-2012.1), the Cochrane Library (Issue3,2011), CNKI (updated to December2011), CBM (updated to December2011) and the Wanfang database (updated to December2011) for randomized controlled trials (RCT) on APBSCT+HDC treatment of SCLC. Hand searches the related field's journals, including magazines, conference proceedings, dissertations and other compilation and use Google and other search methods to find relevant reference on the Internet. According to the inclusion criteria, take in the randomized controlled trials (RCT) of APBSCT+HDC treated SCLC, evaluation of the methodological quality of included studies and extracted the data, The Meta-analyses of studies were conducted using RevMan5.0 software and the Fisher's combined p value method.[Results]A total of6studies and707patients with small cell lung cancer are include, all studies claimed using a random method,all studies did not show that the use of blind method.The effectiveness results of APBSCT+HDC treated SCLC in comparison with conventional dose chemotherapy:①The total effective rate [RR=1.14,95％CI(1.07,1.21)],complete response rate [RR=1.31,95％CI(1.08,1.59)] were significantly increased,the statistically differences were significant(respectively P<0.0001and P=0.006);②partial response rate[RR=1.01,95％CI(0.87,1.19)]no significant improvement(P=0.86);③overall survival [RR=3.74,95％cI (2.13,6.58)],3-year survival rate [RR=1.96,95％CI(1.27,3.02)]was significantly increased,the statistically differences were significant(P<0.00001and P=0.002);④1-year survival rate [RR=1.07,95％CI(0.95,1.20)],2-year survival rate[RR=1.23,95％CI(0.95,1.58)]no significant improvement (P=0.25and0.11, respectively).⑤The median survival,progression-free survival was significantly prolonged, the statistically differences were significant (P <0.025);⑥treatment-related mortality [RR=1.46,95％CI(0.43,4.90)] no significant difference (P=0.54).In terms of toxicity,APBSCT+HDC treatment of SCLC in comparison with conventional dose chemotherapy:①severe degree of red blood cell reduction [RR=1.97,95％CI (1.15,3.38)] and thrombocytopenia [RR=1.93,95％CI (1.06,3.54)]higher incidence,the difference was significance (P values were0.01,0.03);②the incidence of severe neutropenia [RR=1.05,95％CI (0.91,1.21)] no significant difference (P value of0.53);③severe diarrhea [R=16.43,95％CI(2.97,90.95)], mucositis [RR=4.07,95％CI (2.65,6.26)] and infection [RR=5.36,95％CI (2.77,10.36)] prevalence higher,with statistical significance (P values were P=0.001, P <0.00001,P <0.00001)；④severe nausea and vomiting [RR=2.58,95％CI (0.33,19.99)] and severe cardiac toxicity [RR=1.04,95％CI (0.26,4.23)],and severe renal toxicity [RR=5.14,95％CI (0.62,42.92)] and severe neurotoxicity [RR=2.79,95％CI (0.89,8.76)]and other adverse reactions were no significant differences (P values were0.36,0.96,0.13,0.08). [Conclusions] This system review result suggests that autologous peripheral blood stem cell support of high-dose chemotherapy in the treatment of small cell lung cancer compared with conventional dose chemotherapy,①In terms of efficacy, significantly improving the efficiency of the total patients, complete remission rate, overall survival and3-year survival rate; significantly longer median survival of patients and median progression-free survival; not improve patient1,2-year survival rate and partial remission; and not increase treatment-related mortality.②In terms of adverse reactions, the cause of severe red blood cell reduction, severe thrombocytopenia, severe diarrhea, severe mucositis and severe infections were significantly higher. There was no significant difference of causing severe leukopenia, severe nausea and vomiting, severe cardiac toxicity, severe renal toxicity and neurotoxicity. However, due to small sample size included in the study, the above conclusions still need high-quality, large scale randomized controlled trials to confirm. |
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