【摘要】 目的 采用循证医学的方法评价甘露聚糖肽联合顺铂对比单用顺铂治疗恶性胸腔积液的有效性和安全性。 方法 计算机检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库，收集甘露聚糖肽联合顺铂对比单用顺铂治疗恶性胸腔积液的随机对照试验，检索时间为各数据库建库至2011年3月。对文献进行质量评价，用RevMan 5.0软件对数据进行Meta分析。 结果 共纳入6项研究，所有文献质量均为C级。共收入388例患者，Meta分析结果显示甘露聚糖肽联合顺铂组与单用顺铂组相比，总有效率前者高于后者，差异有统计学意义（Plt;0.05）；消化道不良反应发生率两组组间差异无统计学意义（P=0.05）；骨髓抑制发生率前者低于后者，差异有统计学意义（Plt;0.05）；Karnofsky评分提高率前者高于后者，差异有统计学意义（Plt;0.05）。 结论 系统评价表明，甘露聚糖肽联合顺铂治疗恶性胸腔积液的疗效优于单用顺铂的方案。【Abstract】 Objective To assess the clinical efficacy and safety of mannatide plus cisplatin treating malignant pleural effusion. Methods Literatures were retrieved from CBM, VIP, CNKI, Wanfang databases by computer. Literatures were enrolled according to inclusion and exclusion criteria, and the quality of studies was evaluated according to the Cochrane Library handbook. The period duration of searching was between the establishment of the databases and March, 2011. Meta-analysis was conducted by RevMan 5.0 software. Results The meta-analysis of 6 included RCT, all ranked C, which involved 388 patients. The Meta-analysis showed that the total effective rate in mannatide plus cisplatin group significantly differed from that in cisplatin group (P＜0.05). There were no significant difference in the adverse reaction of digestive tract between the two intervention groups (P=0.05). The adverse reaction of marrow depression inmannatide plus cisplatin group was much lower than that in cisplatin group (P＜0.05). The increase of KPS in mannatide plus cisplatin group was higher than that in cisplatin group (P＜0.05). Conclusions The analysis indicates mannatide plus cisplatin has a better effect on malignant pleural effusion than single cisplatin. However, the reliability of this review is affected by poor quality of included studies, and large-scale randomized controlled trials of high quality are needed to confirm the conclusions above.
The management of malignant pleural effusion remains a clinical challenge. In November 2018, American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
ObjectiveTo systematically review the efficacy and safety of intrapleural injection of endostar combined with cisplatin in treatment of non-small cell lung cancer (NSCLC) with malignant pleural effusion. MethodsDatabases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, Web of Science, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about endostar combined with cisplatin for NSCLC with malignant pleural effusion from inception to February 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 10 RCTs involving 610 patients were finally included. The results of meta-analysis showed that: The overall response rate and the improvement rate of quality of life in the endostar combined with cisplatin group were higher than that of the cisplatin alone group (RR=1.71, 95%CI 1.49 to 1.95, P<0.00001; RR=1.68, 95%CI 1.44 to 1.96, P<0.00001, respectively). However, There were no significant differences between two groups in incidence of gastrointestinal reaction, incidence of leucopenia and incidence of thrombocytopenia (all P values>0.05). ConclusionCompared with cisplatin, intrapleural injection of endostar combined with cisplatin can improve the overall response rate and improve the quality of life of NSCLC patients with malignant pleural effusion. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the diagnostic value of neuron specific enolase (NSE) for malignant pleural effusion. MethodsWe comprehensively searched databases including The Cochrane Library (Issue 1, 2012), EMbase, MEDLINE, CBM, CNKI, WanFang Data and VIP from inception to January 2012 to collect studies about the diagnostic value of NSE for malignant pleural effusion. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Then Meta-DiSc software (version 1.4) was used for pooling analysis. ResultsA total of 12 studies were finally included. The results of meta-analysis showed that the value of pooled specificity, sensitivity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio (DOR) were 0.79 (0.76 to 0.84), 0.55 (0.51 to 0.59), 3.2 (1.94 to 5.29), 0.58 (0.45 to 0.74), 7.56 (3.74 to 15.30), respectively; and the area under SROC curve (AUC) was 0.813 1. ConclusionUsing NSE as a maker to diagnose malignant pleural effusion is of certain clinical value, which is used to differentiate benign and malignant pleural effusion.
ObjectiveTo systematically review the efficacy and safety of brucea javanica oil emulsion with/without cisplatin in the treatment of malignant pleural effusion (MPE). MethodsWe electronically search PubMed, The Cochrane Library (Issue 6, 2013), EMbase, CBM, WanFang Data, VIP and CNKI to collect randomized controlled trial about brucea javanica oil emulsion for MPE from the establishment dates to June 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of twenty-five RCTs involving 1 620 patients were included. The results of meta-analysis showed that:compared with using cisplatin alone, brucea javanica oil emulsion plus cisplatin could improve clinical efficiency (RR=1.45, 95%CI 1.34 to 1.57, P < 0.000 01) and patients' quality of life (RR=1.36, 95%CI 1.18 to 1.56, P < 0.000 1), and relieved the incidences of bone marrow depression (OR=0.31, 95%CI 0.22 to 0.42, P < 0.000 01) and digestive tract reaction (OR=0.36, 95%CI 0.24 to 0.54, P < 0.000 01, ) and fever (OR=0.18, 95%CI 0.08 to 0.40, P < 0.000 1). ConclusionCurrent evidence indicates that brucea javanica oil emulsion could improve chemotherapy effects MPE. However, due to the limited quality of the included studies, more high quality studies with large sample size are needed to verify the conclusion.
Objective To overview the systematic reviews of recombinant human endostatin combined with platinum compounds for malignant pleural effusion (MPE). Methods According to the inclusion and exclusion criteria and searching strategies, we screened the systematic reviews of recombinant human endostatin combined with platinum compounds for the treatment of MPE by searching the Embase, PubMed, Clinical Trials, Cochrane Library, China National Knowledge Infrastructure, CQVIP Database and Wanfang Database. The searching time was from January 1999 to December 2021. The methodological quality was evaluated using AMSTAR 2 tool, the report quality was evaluated using PRISMA statement, and the evidence quality of the outcome indicators was graded according to the GRADE system. Finally, RevMan 5.3 software was used to quantitatively merge and analyze the original research effect values of the main outcome indicators with low level of evidence. Results A total of 9 systematic reviews/meta-analyses involving 8 outcome indicators and totally 50 outcomes were included. The average PRISMA scale score was 22.28±1.37, with 6 reports being relatively complete and 3 reports having certain reporting defects. The overall methodological quality of the 9 systematic reviews was extremely low. Most of the 50 outcomes were graded as “low” (31 outcomes) or “intermediate” (18 outcomes) quality. The results of 9 systematic reviews all showed that the clinical efficacy of dual therapy was more satisfactory than that of platinum-based preparations in the treatment of MPE, and re-quantitative analysis also confirmed that there was no statistically significant difference in the incidence of adverse events between the two treatments (P>0.05). Conclusions Considering the existing evidence and the results of meta-analysis, the dual therapy composed of recombinant human endostatin and platinum compounds is more effective in the treatment of MPE, and there is no difference in the incidence of related adverse events. However, because of its poor methodological quality and the low level of evidence, the above conclusions can only provide a certain reference and need to be confirmed by further research.
Objective To evaluate the clinical efficacy and safety of pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion. Methods Twenty-three patients with malignant tumor confirmed by biopsy or postoperative pathology, complicated with malignant pleural effusion confirmed by exfoliative cytology, were treated between March 2013 and June 2014. All the 23 patients underwent thoracic puncture and catheter drainage for the removal of contraindications for chemotherapy. Then, pleural infusion chemotherapy was performed with docetaxel (40 mg/m2), normal saline (250 mL) and dexamethasone (10 mg), 21 days as a cycle. Before pleural infusion chemotherapy with docetaxel, all the patients were given standard pretreatment with dexamethasone, cimetidine/ranitidine or promethazine. The efficacy and safety of the treatment were evaluated in each cycle. Results Among the 23 selected patients, 6 were evaluated as complete remission and 11 as partial remission, with an effective rate of 73.91%. All the patients had acceptable tolerance in the process of the treatment. The most common side effects were bone marrow suppression (78.26%), and nausea and vomiting (82.61%). No such complications as allergy, fluid retention, cardiac toxicity or degree-Ⅳ adverse reactions were detected. Conclusion Pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion is effective with mild adverse reactions, which is worthy to be popularized.