Objective Review the status of the direct health cost of nonsmall-cell lung cancer , and to put forward policy recommendations. Methods Database including PubMed, Cochrane Library and Chinese BioMed were searched, and studies literatures about the direct health cost of nonsmall-cell lung cancer. Results Twenty two studies were analyzed in this paper including 20 foreign studies. Normally, international researches about direct medical cost of treating the nonsmall-cell lung cancer investigate total cost from the first diagnosis until several years later. The discrepancy in the results could be explained by different payments, treatment patterns and research methods in different countries. The direct medical cost of nonsmall-cell lung cancer is expensive especially the cost of in-patient. It’s increase with the time of therapy. Most of the researches in China about direct medical cost of nonsmall-cell lung cancer focus on per in-patient fees. Conclusion Facing the increasingly heavy economic burden of nonsmall-cell lung cancer, to lower the incidence of this disease and to reduce the treatment related cost should be taken into account., the prevention of nonsmall-cell lung cancer carcinoma should be enhanced, Such as tobacco control, environment improvement, etc. A proper incentive mechanism should be established.
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.
Objective To evaluate the diagnostic value of serum neuron specific enolase (NSE) in patients with small cell lung cancer. Methods We searched MEDLINE, EMBASE, The Cochrane Library and other databases (1966 to March 2007) to collect studies which evaluated the diagnostic value of NSE in patients with small cell lung cancer. The heterogeneity of 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 Fifteen studies involving 4221 patients (672 SCLC and 3549 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=66.1%), the pooled sensitivity was 0.67 (95%CI 0.64 to 0.71) and the pooled specificity was 0.91 (95%CI 0.90 to 0.92). Subgroup analyses indicated that 4 of the studies which used the reagent supplied by The Academy of Military Medical Sciences (P=0.33, I2=13.4%, AUC= 0.9672, SE=0.0393) and another 4 which used the reagent supplied by Roche (P=0.23, I2=29.9%, AUC=0.8311, SE=0.0836) had no heterogeneity. Conclusion NSE could be regarded as one of the reference tests in patients with small cell lung cancer, 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.