Objective To Evaluation of Accuracy and Quality of Diagnostic Test of CEA for the Diagnosis of NSCLC in Chinese Patients. Methods We searched Chinese Biological Medicine Database (CBM, 1978 to 2009) and China National Knowledge Infrastructure (CNKI, 1994 to 2009). Diagnostic tests of CEA for the diagnosis of NSCLC were included. Data were extracted, and the quality of included studies was evaluated according to the six criteria of diagnostic tests. The heterogeneity test and The Summary Receiver Operating Characteristic (SROC) curve and meta-analyses were performed by MetaDisc. Results A total of 84 relevant articles were retrieved and 11 were included in our review. Eleven studies involving 925 patients (861 NSCLC patients, all diagnosed by the gold standard) were included. Meta-analyses showed that the heterogeneity among studies was high (P=0.000 2, I2=69.1%), the pooled sensitivity was 0.542 and the pooled specificity was 0.869. Subgroup analyses indicated that 5 of the studies which used the ECLIA (P=0.376, I2=5.4%, AUC= 0.748 3) and 4 of the studies which lung adenocarcinoma (P=0.186, I2=37.6%, AUC=0.900 2) and 4 of the studies which lung squamous cell carcinoma (P=0.955，I2=0.00%, AUC=0.762 0) had no heterogeneity. serum CEA is low sensitive and high specific on the diagnosis of NSCLC. The sensitivity and diagnostic accuracy rate of CEA were higher in adenocarcionoma than squamous cell cance. Conclusion CEA could be regarded as one of the reference tests in patients with NSCLC, Serum CEA is more sensitive and specific than lung squamous cell carcinoma on lung adenocarcinoma. but more high quality trials are required.
Objective To assess the clinical efficacy and safety of paclitaxel in the first-line and second-line treatment of patients with small cell lung cancer (SCLC). Methods We searched The Cochrane Library, MEDLINE, EMBASE, CBM, CNKI, VIP and etc to collect all clinical controlled trials involving the addition of paclitaxel to chemotherapy in SCLC patients. Two reviewers evaluated the quality of included trials independently. The Cochrane Collaboration’s software RevMan 4.2.2 was used for meta-analyses. Results Nine trials involving 1675 SCLC patients were included. Five trials were randomized controlled trials, and all trails didn’t mention the blinding methods. Meta analyses indicated that the PET arm (paclitaxel+cisplatin+etoposide) had a similar response rate compared with the EP arm (etoposide+cisplatin) (OR1.35, 95%CI 0.98 to 1.85). The incidences of severe thrombocytopenia (OR 1.68, 95%CI 1.12 to 2.52) and lethal toxicity (OR 4.00, 95%CI 1.77 to 9.04) were higher in the PET arm than those in the EP arm, but the incidence of severe leukocytopenia was lower in the PET arm (OR 0.50, 95%CI 0.37 to 0.68). A total of 54 treatment-related deaths were reported. Conclusion In the first-line treatment of SCLC, the combination of paclitaxel, carboplatin and etoposide improved the progression-free survival, but the combination of paclitaxel and EP did not improve the survival and was more toxic than EP alone. Paclitaxel as the second-line treatment showed some therapeutic effect. Due to the poor quality and small sample size of included trials, more well-designed multi-center randomized controlled trials should be performed.
Objective To evaluate the role of topotecan in the treatment of small cell lung cancer (SCLC). Methods Up to 2006, we searched The Cochrane Library, MEDLINE, EMbase, Cancerlit, CBM, CNKI and VIP. Handsearch and additional search were also conducted. The quality of included studies was evaluated and meta-analyses were performed for the results of homogeneous studies by RevMan 4.2.8 software. Results Fourteen studies involving 2 099 participants with SCLC were included. All included studies were adequate in reporting randomization, while inadequate in allocation concealment and blinding. Meta-analyses showed that the response rate of TP (topotecan + cisplatin) regimen had no significant difference compared with EP regimen (etoposide + cisplatin) with OR 0.83 and 95%CI 0.63 to 1.09, but myelo-suppression such as leucopenia and thrombopenia was more severe with TP regimen; the response rate of monotherapy with topotecan was similar with that of CE (carboplatin + etoposide) regimen with OR 0.59 and 95%CI 0.22 to 1.60; the response rate of TEP (topotecan + etoposide + cisplatin) regimen was comparable with that of EP regimen with OR 1.37 and 95%CI 0.82 to –2.28, but myelosuppression and anemia were more severe with TEP regimen; the response rate with OR 0.97 and 95％CI 0.60 to –1.57, median time to progression with WMD –2.32 and 95％CI –5.72 to 1.09 and median survival time with WMD –1.65 and 95％CI –7.13 to 3.83 of IV topotecan were similar to those of oral topotecan, while neutropenia was more severe with IV topotecan. Forty-five treatment-related deaths were reported in all included studies. Conclusions Topotecan is an effective agent for SCLC when used as monotherapy or in combined treatment, but myelosuppression such as leucopenia and thrombopenia was relatively severe. Although it has been recommended as a second-line agent for recurrence of sensitive SCLC, more clinical trials are needed to define its role in first-line treatment. Due to a high risk of selection bias and detection bias in included studies, the evidence is insufficient to determine the effect of topotecan. Further large-scale trials are required to define the role of topotecan in the treatment of SCLC.
Objective To evaluate the diagnostic value of serum pro-gastrin-releasing peptide (Pro-GRP) in patients with small cell lung cancer. Methods We searched MEDLINE, EMBASE, The Cochrane Library and other databases (1966 to Sept 2009) to collect studies which evaluated the diagnostic value of Pro-GRP in patients with small cell lung cancer. The heterogeneity of the included studies was tested by the Cochrane Collaboration’s software RevMan 4.2. The Summary Receiver Operating Characteristic (SROC) curve and meta-analyses were performed by MetaDisc. Results A total of 256 relevant articles were retrieved and 19 were included in our review. Eleven studies involving 1 447 patients were included. Meta-analyses showed that the heterogeneity among studies was high (P﹤0.000 01, I2=69.3%), the pooled sensitivity was 0.717 and the pooled specificity was 0.963. Subgroup analyses indicated that 9 of the studies which used the LD (Limited diseases) SCLC group (P=0.003, I2=65.5%, SEN=0.637, SPE=0.968, SROC AUC=0.724 3) had heterogeneity and ED (Extensive diseases) SCLC group (P=0.2, I2=27.0%, SEN=0.766, SPE=0.968, SROC AUC=0.935 5) had no heterogeneity. And 15 of the studies of Pro-GRP which were determined by acmmercial sandwich ELISA (Japan) group (P=0.000 1, I2=68.5%) had heterogeneity. Three of the studies of Pro-GRP which were determined by ELISA (Germany) group (P=0.948 7, I2=0.001%) had no heterogeneity. Conclusion Pro-GRP could be regarded as one of the reference tests in patients with small cell lung cancer, but higher quality trials are required.
Small cell lung cancer is a pathological type with higher malignancy in lung cancer, and has biological characteristics different from non-small cell lung cancer, such as rapid growth, high malignancy and poor prognosis. Mediastinal lymph node and distant metastasis occur frequently. In recent years, the treatment of limited-stage small cell lung cancer has been stagnant, and various treatments are poor. The operation is mainly suitable for patients with small cell lung cancer (T1-2N0M0). Small cell lung cancer has strong sensitivity to chemotherapy, but the clinical application of neoadjuvant chemotherapy in T1-2N0M0 small cell lung cancer remains controversial. This article reviewed the value of neoadjuvant chemotherapy in the treatment of T1-2N0M0 small cell lung cancer.
Objectives To evaluate the efficacy of interferon (IFN) maintenance therapy in patients with small cell lung cancer (SCLC). Methods We searched MEDLINE (1966-Jan.2006), EMbase (1984-Jan.2006), The Cochrane Library(Issue 1, 2006)and the Chinese Biomedical Database (1980-Jan.2006). We checked the references in the reports of related studies and handsearched the education books of ASCO and ESMO meetings. The quality of the included trials was evaluated. Data were extracted by two reviewers independently into a specially designed extraction form. The Cochrane Collaboration’s RevMan 4.2.7 software was used for data analysis. Results Five randomized controlled trials involving 587 patients were included. The pooled result of the 5 studies showed that IFN plus chemotherapy induction treatment did not have a significant effect on 1-year (RR 1.19, 95%CI 0.88-1.6) or 2-year survival rate (RR 1.44, 95% CI 0.99-2.10). However, IFN maintenance therapy significantly increased 2-year (RR 2.08, 95%CI 1.16-3.72) and 1-year survival (RR 2.99, 95%CI 1.13-7.93). Conclusion IFN maintenance therapy may increase 2-year and 1-year survival rates after patients have achieved complete or partial response to chemotherapy. Further randomized, double-blind multi-center trials are needed to investigate this further.
Objective To investigate the significance of neoadjuvant chemotherapy in the treatment of limited-disease small cell lung cancer (LD-SCLC). Methods We retrospectively analyzed the clinical data of 55 LD-SCLC patients who underwent surgery in the Department of Thoracic Surgery, China-Japan Friendship Hospital from May 2007 to August 2016. There were 42 males and 13 females with a mean age of 57 years. All patients underwent clinical staging before treatment. According to the different treatments, the patients were divided into two groups, a preoperative neoadjuvant chemotherapy group and a direct surgery group. The comparison of long-term survival rates was made between the two groups. Results Among the 55 patients, median survival time was 27 months. The 1-, 3-, 5-year survival rate was 89.1%, 45.0%, 33.8% respectively. Treatment methods and clinical N stage were significantly different in prognosis (P<0. 05). The results of Cox proportional hazards regression model showed that clinical N stage was prognostic factor of LD-SCLC patients (P<0. 05). Conclusion Patients with clinical stage Ⅰ and Ⅱ SCLC are better to receive direct surgery. For patients with clinical stage Ⅲ, it is recommended to reach partial response or complete response with neoadjuvant chemotherapy before surgery. The status of lymph node metastasis is closely related to survival, thus identifying the accurate clinical stage is crucial before treatment.
TNM system should be used in the staging of small cell lung cancer (SCLC), especially in the limited stages of SCLC. Preoperative staging should be strengthened to avoid invalid operation due to insufficient diagnosis. Retrospective studies showed that the efficacy of surgery (+ chemotherapy) in early SCLC is comparable to the outcome of resection for early stage non-small cell lung cancer, which shakes the concept of "chemotherapy/chemoradiotherapy as the main treatment of SCLC". The best operative procedure of SCLC is lobectomy. Sub-lobectomy and pneumonectomy are inferior to that of lobectomy, but still better than chemotherapy/chemo-radiotherapy in terms to long term survival. All these findings need to be confirmed by large sample prospective randomized studies.
Objective To evaluate the prognostic value of the level of serum neurone specific enolase (NSE) in patients with small cell lung cancer (SCLC). Methods We searched MEDLINE, EMbase, CBMdisc, and The Cochrane Central Register of Controlled Trials (1950 to December 2007). Studies meeting the eligibility criteria were retrieved and their bibliographies were checked for other relevant publications. The quality of included studies was evaluated by 2 reviewers independently. Meta-analyses were performed for the results of homogeneous studies using STATA 7.0 software. Results Nine studies involving 2 021 SCLC patients were included. About 66.0% of patients had high serum levels of NSE, according to the cut-off value defined by the authors. The hazard ratio (HR) of high levels of NSE for overall survival (OS) was 1.27 times of that of low levels of NSE for OS in SCLC patients (95% CI 1.19 to 1.35, P=0.281). Conclusion Patients with high levels of NSE appear to have a poorer OS compared with those with low levels of NSE, thus the level of NSE has a prognostic value in SCLC patients. Due to the potential publication bias, selection bias, and measurement bias among these studies, the conclusion should be interpreted carefully. More high-quality homogeneous studies are required to accurately evaluate the prognostic value of NSE.
The National Comprehensive Cancer Network (NCCN) released the latest version 1, 2022 of "NCCN guidelines for the clinical diagnosis and treatment of small cell lung cancer" (hereinafter referred to as "guideline"). Based on high-quality evidence-based medicine, this guideline provides references of clinical diagnosis and treatment for clinicians around the world. Compared with the version 3, 2021 of the "guideline", updates and revisions mainly focused on the progress of radiotherapy and systemic treatment. This article will interpret the updated therapy content in this new version of the "guideline".