The efficacy and safety of endostar combined gemcitabine and cisplatin in the treatment of non-small cell lung cancer: a meta-analysis

WANG, Yixin; WANG, Lei; GUO, Jia; WANG, Ziyu; HUA, Shucheng

doi:10.1590/fst.40720

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Original Article • Food Sci. Technol (Campinas) 42 • 2022 • https://doi.org/10.1590/fst.40720 copy

The efficacy and safety of endostar combined gemcitabine and cisplatin in the treatment of non-small cell lung cancer: a meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

To determine the efficacy and safety of Endostar combined with gemcitabine and cisplatin in the treatment of NSCLC, and provide evidence-based reference for clinical drug use. Retrieved from Cochrane Library, PubMed, Embase, ClinicalTrials, CNKI, Wanfang and VIP database, randomized controlled trials (RCT) were collected. Pooled standard mean differences (SMD) and 95% confidence intervals (CI) were analyzed using R software with a random-effects model. Data from a total of 27 RCTs were included, involving 1646 patients were analyzed. Results of meta-analysis showed that response rate and clinical benefit rate of trial group were significantly higher than those of control group. There was no statistical significance in the incidence of leucopenia, thrombocytopenia and gastrointestinal reaction between 2 groups. The results showed that Endostar combined with gemcitabine and cisplatin may generally improve therapeutic efficacy of NSCLC patients, without increasing the incidence of adverse reactions.

Keywords:
endostar; gemcitabine; cisplatin; non-small cell lung cancer; meta-analysis

Included trails	Pathological staging	Course, d	Intervention		Sample size		Age mean (SD) (years)		Outcome measures	Jadad评分
Included trails	Pathological staging	Course, d	Control group	Trial group	Control group	Trial group	Control group	Trial group	Outcome measures	Jadad评分
Tan et al. (2013)Tan, Y., Zhang, T., Peng, J. J., & Zhao, Y. (2013). Short-term Efficacy and Safety of Recombinant Human Endostatin Combined with GP Regimen in the Treatment of Advanced Non-small Cell Lung Cancer. China Pharmacy, 24(36), 3416-3418.	IIIb~IV	21	Gemcitabine(G) 1000 mg/m², intravenous injection (ij), qd, d1-8+Cisplatin (C) 25 mg/m², ij, qd, d_1-3	The same chemotherapy as control group+ Endostar (E) 7.5 mg/m² with 0.9% sodium chloride injection (SCI) 500 mL, intravenous injection (ij), qd, d_1-14	38	38	61.7 ± 9.8		①②③④⑤	3
Xie & Huang (2009)Xie, Y. R., & Huang, J. J. (2009). Clinical study of Endostar combined GP regimen in the treatment of advanced non-small cell lung cancer. Chinese Journal of Gerontolog, 29(16), 2035-2037.	III~ IV	21	G1000 mg/m², d₁ and d₈+ C75 mg/m², ij, qd, d_1-3	The same chemotherapy as control group+E 15 mg with 0.9% SCI 500 mL, d_1-14, ij	26	22	56.5	59	①②③④⑤	2
Chen et al. (2010)Chen, Y. X., Cheng, H. N., & Chen, L. (2010). Efficacy of endostar combined with vinorelbine and cisplatin in treatment of advanced non-small-cell Lung cancer. Hainan Medical Journal, 21(18), 20-22.	IIIb~IV	21	G 1000 mg/m², ij, d₁ and d₈+C 25 mg/m², ij, d_1-3	The same chemotherapy as control group+E 15 mg with 0.9% SCI 500 mL, d_1-14, ij	25	30	49 ± 3	50 ± 2	①②③④⑤	1
Gu et al. (2010)Gu, Y., Lu, H. Y., & Jiang, A. G. (2010). Clinical study of recombinant human endostatin combined with GP regimen for advanced non-small cell lung cancer. Journal of Clinical Medicine in Practice, 14(9), 86-87.	IIIb~IV	21	G 1000 mg/m², d₁ and d₈+C 25 mg/m², ij, d_1-3	The same chemotherapy as control group+E 15 mg with 0.9% SCI 500 mL, d_1-14, ij	33	27	53.6		①②③④⑤	1
Guo (2010)Guo, H. B. (2010). Efficacy of endostar combined with chemotherapy in the treatment of advanced non-small cell lung cancer. Chinese and Foreign Health Digest, 7(33), 120.	III~ IV	21	G 1000 mg/m², ij, d₁ and d₈+C 30 mg/m², ij, d_1-3	The same chemotherapy as control group+E15 mg, ij, d_1-14	38	38	55 ± 12	53 ± 14	① ②④	2
Wei et al. (2010)Wei, Q. H., Ding, H. Z., & Tao, Y. J. (2010). Observation of treating advanced non- small cell lung cancer with recombinant human endostatin combined with GP. Journal of Clinical Medicine in Practice, 14(1), 36-38.	IIIb~IV	21	G1g/m², ij, d₁ and d₈+ C 30 mg/m², ij, d_2-4	The same chemotherapy as control group+E15 mg, qd, d_1-14, ij	16	16	59.8		①②③④⑤	2
Xu (2010)Xu, J. (2010). Evaluation of clinical efficacy of recombinant human endostatin combined with interventional therapy in non-small cell lung cancer. Guangzhou: China Southern Medical University.	IIIb~IV	36	G1000 mg/m² +C 30 mg/m²,Tumor target artery perfusion, d₁; G1000 mg/m², ij, d₈+0.9% SCI 500 mL, ij, d_2-12	G 1000 m g/m²+C 30 mg/m²,Tumor target artery perfusion, d₁;G 1000 mg/m², ij, d₈,E 15 mg/d+0.9% SCI 500 mL, ij, d_2-12	20	20	64		①②③④⑤	2
Chen et al. (2011)Chen, Q., Xie, Q., & Shi, Q. (2011). Short-term efficacy of YH-16 combined with GP regimen for advanced non-small cell lung cancer. Zhongliu Fangzhi Yanjiu, 38(2), 199-201.	III~ IV	21	G1000 mg/m², ij, d₁、d₈+C80 mg/m², ij, d₁	The same chemotherapy as control group+E 15 mg with 0.9% SCI 500 mL, d_1-14, ij	35	33	65	63	①②③④⑤	1
Ruan & Sun (2011)Ruan, M., & Sun, L. Y. (2011). Observation on the efficacy of recombinant human endostatin combined with GP regimen in the treatment of advanced non-small cell lung cancer. Chinese and Foreign Health Digest, 8(30), 54-55.	IIIb~IV	21	G1000 mg/m², d₁ and d₈+C75 mg/m², ij, d_1-3	The same chemotherapy as control group+E 15 mg with 0.9% SCI 500 mL, d_1-14, ij	19	17	58.5		①②③⑤	1
Wang (2011)Wang, F. (2011). Clinical study of endostar combined with GP regimen in the treatment of advanced non-small cell lung cancer. Medicina Infantil, 24(11), 118-119.	IIIb~IV	21	G 1000 mg/m², ij, d₁ and d₈+C 75 mg/m², ij, d₁	The same chemotherapy as control group+E 15 mg with 0.9% SCI500 mL, d_1-14, ij	29	31	55	56	① ②	1
Zheng et al. (2011)Zheng, Q. P., Luo, Z. X., & Li, J. (2011). Clinical observation of endostatin combined with GP regimen in the treatment of stage IV non-small cell lung cancer. Guangxi Medical Journal, 33(5), 564-565.	IV	21-28	G 1000 mg/m², ij, d₁ and d₈+Cisplatin 20 mg/m², intravenous injection, d_1-5	The same chemotherapy as control group+Endostar 15 mg/d, d_1-14	18	17	54.5	50.1	①②⑤	1
Chen & Yang (2012)Chen, B., & Yang, W. B. (2012). Observation of curative effect of recombinant human endostatin combined with GP regimen on non-small cell lung cancer. Journal of Clinical Pulmonary Medicine, 17(5), 869-870.	Not mentioned	14	Gemcitabine 1000 mg/m² wiht 0.9% Sodium chloride injection 100 mL, intravenous injection, d₁ and d₈+Cisplatin 25 mg/m² with 0.9%Sodium chloride injection 500 mL, intravenous injection, d_2-4	The same chemotherapy as control group+Endostar 15 mg, intravenous injection, qd, d_1-14	26	27	56.5 ± 7.3	55.7 ± 8.6	①②③④⑤	1
He (2012)He, R. (2012). Analysis on efficacy of endostar combined with cisplatin chemotherapy in treatment of senile advanced non -small cell lung cancer. Practical Preventive Medicine, 19(8), 1230-1232.	III~ IV	21	Gemcitabine 1000 mg/m², d₁ and d₈+Cisplatin 30 mg/m², d_2-4	The same chemotherapy as control group+Endostar 7.5 mg/m², d_1-14	32	40	69.8 ± 5.5	70.5 ± 5.3	①②⑤	1
Liu et al. (2012)Liu, J. W., Geng, L., & Liu, Z. W. (2012). Efficacy of endo combined with GP chemotherapy in the treatment of non-small cell lung cancer. Monthly Psychiatrist, 17, 121-122.	IIIb~IV	21	Gemcitabine 1000 mg/m², intravenous injection, d₁ and d₈+Cisplatin 75 mg/m², intravenous injection	The same chemotherapy as control group+Endostar 15 mg, d_1-7	30	30	56	58	①②③④⑤	2
Luan (2012)Luan, W. Q. (2012). Relationship between circulating endothelial progenitor cells and Endostar in non-small cell lung cancer. Zhengzhou: Zhengzhou Univerisity.	III~ IV	21	Gemcitabine 1250 mg/m², intravenous injection, d₁ and d₈+Cisplatin 75 mg/m², intravenous injection, d₁	The same chemotherapy as control group+Endostar 75 mg/m² with 0.9% Sodium chloride injection 500 mL, d_1-14, intravenous injection	27	25	40-67	42-68	① ②	1
Yin et al. (2012)Yin, F., Wu, L., & He, W. (2012). Clinical application of recombinant human endostatin combined with GP protocol in advanced non-small cell lung cancer. Journal of Clinical Pulmonary Medicine, 17(11), 2098-2099.	Not mentioned	21	Gemcitabine 1000 mg/m², intravenous injection, d₁ and d₈+Cisplatin 30 mg/m², intravenous injection, d_2-4	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 500 mL, intravenous injection, qd, d_1-14	90	94	49.3 ± 4.5	48.3 ± 5.2	①②⑤	1
Alimujiang et al. (2013)Alimujiang, S., Zhang, T., Patiguli, A., & Liu, L. (2013). Clinical analysis of recombinant human endostatin combined with gemcitabine and cisplatin therapy in advanced non-small cell lung cancer. Shandong Daxue Xuebao. Yixue Ban, 51(3), 95-98.	IIIb~IV	21	Gemcitabine 1.0 g/m² with 250 mL 0.9% Sodium chloride injection, d₁ and d₁₄, intravenous injection +Cisplatin with 500 mL 0.9% Sodium chloride injection, intravenous injection, d_1-3	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 500 mL, d_1-14, intravenous injection	40	40	59.2 ± 9.5	58.3 ± 9.6	①②③④⑤	2
Zhang (2014)Zhang, Y. Y. (2014). Clinical study of first-line treatment of advanced human squamous cell carcinoma with recombinant human endostatin (endostar) combined with chemotherapy (GP protocol). Hangzhou: Zhejiang University.	IIIb~IV	21	Gemcitabine 1000 mg/m², d₁ and d₈+Cisplatin 75 mg/m², dosing in 3 days	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 250 mL, Intravenous pumping, d_1-9	28	31	54	53	①②③④⑤	2
Fu et al. (2015)Fu, H., Yuan, C. P., & Xiao, C. J. (2015). Short term efficacy of Endostar combined with GP regimen in the treatment of advanced non-small cell lung cancer. Journal of Taishan Medical College, 36(12), 1367-1368.	IIIb~IV	21	Gemcitabine 1000 mg/m², intravenous injection, d₁ and d₈+Cisplatin 25 mg/m², intravenous injection, d_1-3	The same chemotherapy as control group+Endostar15 mg with 0.9% Sodium chloride injection 500 mL, d_1-14, intravenous injection	28	32	55.81	56.21	①②③④⑤	2
Liu (2015)Liu, T. (2015). Clinical efficacy of GP regimen combined with Endostar in the treatment of advanced non-small cell lung cancer. China Practical Medicine, 10(2), 43-44.	III~ IV	21	Gemcitabine 1000 mg/m², intravenous injection, d₁ and d₈+Cisplatin 80 mg/m², intravenous injection, d_1-2	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 500 mL, d_1-14	32	32	无		① ②	2
Li et al. (2016)Li, L. H., Fu, Y. M., & Jin, Z. (2016). Investigation of gemcitabine combined with endostatin in the treatment of advanced non-small cell lung cancer. Jiangxi Medical Journal, 51(12), 1412-1414.	IIIb~IV	21	Gemcitabine 1000 mg/m², intravenous injection, d₁ and d₈+Cisplatin 30 mg/m², intravenous injection, d_1-3	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 500 mL, d_1-14, intravenous injection	23	23	52.3 ± 10.6		①②③④⑤	3
Fang (2017)Fang, L. (2017). Clinical observation on efficacy of recombinant human endostatin combined with chemotherapy for advanced non-small cell lung cancer. Journal of Medical Forum, 38(8), 49-50.	Not mentioned	21	Gemcitabine 1000 mg/m², intravenous injection, d₁ and d₈+Cisplatin 75 mg/m², intravenous injection,used 3 days continuously	The same chemotherapy as control group+Endostar 7.5 mg/m² with 0.9% Sodium chloride injection 500 mL, qd, d_1-14	23	23	52	60	① ②	2
Jia et al. (2017)Jia, X. Q., Sun, Q. Y., & Wen, Z. P. (2017). Clinical observation of recombinant human endostatin combined with gemcitabine and cisplatin therapy in advanced non-small cell lung cancer. Inner Mongolia Medical Journal, 49(1), 29-32.	IIIb~IV	21	Gemcitabine 1.0 mg/m² with 0.9% Sodium chloride injection 150 mL, intravenous injection, d₁ and d₈+Cisplatin 25 mg/m² with 0.9% Sodium chloride injection 500 mL, intravenous injection, d_1-3	The same chemotherapy as control group+Endostar 30 mgwith 0.9% Sodium chloride injection 110 mL, d_1-7	20	20	50 ± 2		①②③④⑤	2
Xu & Wu (2017)Xu, L., & Wu, L. (2017). Clinical observation of recombinant human endostatin combined with GP chemotherapy for advanced non-small cell lung cancer. Chinese Journal of Clinical Rational Drug Use, 10(13), 91-92.	Not mentioned	21	Gemcitabine 1.0 g/m² wiht 0.9% Sodium chloride injection 250 mL, intravenous injection, d₁ and d₈+Cisplatin 30 mg/m² with 0.9% Sodium chloride injection 500 mL, intravenous injection, d_1-3	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 500 mL, intravenous injection, d_1-14	35	35	54.1 ± 11.3		①②③⑤	3
Song et al. (2018)Song, W. C., Bao, Y., & Qian, J. (2018). Study on clinical efficacy of endostar combined with gemcitabine and cisplatin in the treatment of advanced lung squamous cell carcinoma and effect on quality of life. The Practical Journal of Cancer, 33(1), 59-62.	III~ IV	21	Gemcitabine 1250 mg/m², intravenous injection, d₁ and d₈+Cisplatin 25 mg/m², intravenous injection, d_1-3	The same chemotherapy as control group+Endostar 15 mg/m², d_1-7, intravenous injection	30	30	61.7	57.4	①②③④⑤	1
Wang (2018)Wang, Z. F. (2018). Effects of endo combined with first-line GP chemotherapy on survival time and quality of life in patients with advanced lung squamous cell carcinoma. Journal of Medical Theory and Practice, 31(2), 210-211.	IIIb~IV	21	Gemcitabine 1000 mg/m² with 0.9% Sodium chloride injection 100 mL, intravenous injection, d₁ and d₂ applied Cisplatin 75 mg/m² with 0.9% Sodium chloride injection 500 mL, intravenous injection, dosing in 3 days	The same chemotherapy as control group+Endostar 15 mg with 0.9% Sodium chloride injection 250 mL, intravenous pumping, d_1-9	30	34	55.45	55.97	①②③④⑤	1
Zhong & Chen (2018)Zhong, L., & Chen, F. C. (2018). Efficacy and safety of Endostar combined with chemotherapy in the treatment of advanced non-small cell lung cancer. Chinese Manipulation & Rehabilitation Medicine, 9(2), 66-67.	Not mentioned	21	Gemcitabine 1000 mg/m² with 0.9% Sodium chloride injection 150 mL, intravenous injection, d₁ and d₈ applied Cisplatin 30 mg/m² with 0.9% Sodium chloride injection 500 mL, intravenous injection, d_1-3	The same chemotherapy as control group+Endostar 7.5 mg/m² with 0.9% Sodium chloride injection 100 mL, d_1-14	25	25	70.34	70.21	①②③④⑤	2

Excluded trails	Heterogeneity		95% CI	P
Tan et al. (2013)Tan, Y., Zhang, T., Peng, J. J., & Zhao, Y. (2013). Short-term Efficacy and Safety of Recombinant Human Endostatin Combined with GP Regimen in the Treatment of Advanced Non-small Cell Lung Cancer. China Pharmacy, 24(36), 3416-3418.	P=0.99	I²=0	1.67(1.47, 1.89)	P<0.000 01
Xie & Huang (2009)Xie, Y. R., & Huang, J. J. (2009). Clinical study of Endostar combined GP regimen in the treatment of advanced non-small cell lung cancer. Chinese Journal of Gerontolog, 29(16), 2035-2037.	P=0.99	I²=0	1.68(1.48, 1.90)	P<0.000 01
Chen et al. (2010)Chen, Y. X., Cheng, H. N., & Chen, L. (2010). Efficacy of endostar combined with vinorelbine and cisplatin in treatment of advanced non-small-cell Lung cancer. Hainan Medical Journal, 21(18), 20-22.	P=0.99	I²=0	1.66(1.46, 1.88)	P<0.000 01
Gu et al. (2010)Gu, Y., Lu, H. Y., & Jiang, A. G. (2010). Clinical study of recombinant human endostatin combined with GP regimen for advanced non-small cell lung cancer. Journal of Clinical Medicine in Practice, 14(9), 86-87.	P=1.00	I²=0	1.65(1.45, 1.86)	P<0.000 01
Guo (2010)Guo, H. B. (2010). Efficacy of endostar combined with chemotherapy in the treatment of advanced non-small cell lung cancer. Chinese and Foreign Health Digest, 7(33), 120.	P=0.99	I²=0	1.67(1.47, 1.90)	P<0.000 01
Wei et al. (2010)Wei, Q. H., Ding, H. Z., & Tao, Y. J. (2010). Observation of treating advanced non- small cell lung cancer with recombinant human endostatin combined with GP. Journal of Clinical Medicine in Practice, 14(1), 36-38.	P=0.99	I²=0	1.67(1.47, 1.89)	P<0.000 01
Xu (2010)Xu, J. (2010). Evaluation of clinical efficacy of recombinant human endostatin combined with interventional therapy in non-small cell lung cancer. Guangzhou: China Southern Medical University.	P=1.00	I²=0	1.65(1.46, 1.87)	P<0.000 01
Chen et al. (2011)Chen, Q., Xie, Q., & Shi, Q. (2011). Short-term efficacy of YH-16 combined with GP regimen for advanced non-small cell lung cancer. Zhongliu Fangzhi Yanjiu, 38(2), 199-201.	P=0.99	I²=0	1.69(1.49, 1.92)	P<0.000 01
Ruan & Sun (2011)Ruan, M., & Sun, L. Y. (2011). Observation on the efficacy of recombinant human endostatin combined with GP regimen in the treatment of advanced non-small cell lung cancer. Chinese and Foreign Health Digest, 8(30), 54-55.	P=0.99	I²=0	1.66(1.47, 1.89)	P<0.000 01
Wang (2011)Wang, F. (2011). Clinical study of endostar combined with GP regimen in the treatment of advanced non-small cell lung cancer. Medicina Infantil, 24(11), 118-119.	P=1.00	I²=0	1.70(1.50, 1.93)	P<0.000 01
Zheng et al. (2011)Zheng, Q. P., Luo, Z. X., & Li, J. (2011). Clinical observation of endostatin combined with GP regimen in the treatment of stage IV non-small cell lung cancer. Guangxi Medical Journal, 33(5), 564-565.	P=0.99	I²=0	1.67(1.47, 1.89)	P<0.000 01
Chen & Yang (2012)Chen, B., & Yang, W. B. (2012). Observation of curative effect of recombinant human endostatin combined with GP regimen on non-small cell lung cancer. Journal of Clinical Pulmonary Medicine, 17(5), 869-870.	P=0.99	I²=0	1.69(1.48, 1.91)	P<0.000 01
He (2012)He, R. (2012). Analysis on efficacy of endostar combined with cisplatin chemotherapy in treatment of senile advanced non -small cell lung cancer. Practical Preventive Medicine, 19(8), 1230-1232.	P=0.99	I²=0	1.68(1.48, 1.91)	P<0.000 01
Liu et al. (2012)Liu, J. W., Geng, L., & Liu, Z. W. (2012). Efficacy of endo combined with GP chemotherapy in the treatment of non-small cell lung cancer. Monthly Psychiatrist, 17, 121-122.	P=1.00	I²=0	1.70(1.50, 1.93)	P<0.000 01
Luan (2012)Luan, W. Q. (2012). Relationship between circulating endothelial progenitor cells and Endostar in non-small cell lung cancer. Zhengzhou: Zhengzhou Univerisity.	P=0.99	I²=0	1.67(1.48, 1.90)	P<0.000 01
Yin et al. (2012)Yin, F., Wu, L., & He, W. (2012). Clinical application of recombinant human endostatin combined with GP protocol in advanced non-small cell lung cancer. Journal of Clinical Pulmonary Medicine, 17(11), 2098-2099.	P=0.99	I²=0	1.66(1.45, 1.90)	P<0.000 01
Alimujiang et al. (2013)Alimujiang, S., Zhang, T., Patiguli, A., & Liu, L. (2013). Clinical analysis of recombinant human endostatin combined with gemcitabine and cisplatin therapy in advanced non-small cell lung cancer. Shandong Daxue Xuebao. Yixue Ban, 51(3), 95-98.	P=0.99	I²=0	1.69(1.49, 1.92)	P<0.000 01
Zhang (2014)Zhang, Y. Y. (2014). Clinical study of first-line treatment of advanced human squamous cell carcinoma with recombinant human endostatin (endostar) combined with chemotherapy (GP protocol). Hangzhou: Zhejiang University.	P=0.99	I²=0	1.68(1.48, 1.91)	P<0.000 01
Fu et al. (2015)Fu, H., Yuan, C. P., & Xiao, C. J. (2015). Short term efficacy of Endostar combined with GP regimen in the treatment of advanced non-small cell lung cancer. Journal of Taishan Medical College, 36(12), 1367-1368.	P=0.99	I²=0	1.67(1.47, 1.89)	P<0.000 01
Liu (2015)Liu, T. (2015). Clinical efficacy of GP regimen combined with Endostar in the treatment of advanced non-small cell lung cancer. China Practical Medicine, 10(2), 43-44.	P=0.99	I²=0	1.68(1.48, 1.90)	P<0.000 01
Li et al. (2016)Li, L. H., Fu, Y. M., & Jin, Z. (2016). Investigation of gemcitabine combined with endostatin in the treatment of advanced non-small cell lung cancer. Jiangxi Medical Journal, 51(12), 1412-1414.	P=0.99	I²=0	1.68(1.48, 1.91)	P<0.000 01
Fang (2017)Fang, L. (2017). Clinical observation on efficacy of recombinant human endostatin combined with chemotherapy for advanced non-small cell lung cancer. Journal of Medical Forum, 38(8), 49-50.	P=0.99	I²=0	1.66(1.47, 1.89)	P<0.000 01
Jia et al. (2017)Jia, X. Q., Sun, Q. Y., & Wen, Z. P. (2017). Clinical observation of recombinant human endostatin combined with gemcitabine and cisplatin therapy in advanced non-small cell lung cancer. Inner Mongolia Medical Journal, 49(1), 29-32.	P=0.99	I²=0	1.68(1.48, 1.90)	P<0.000 01
Xu & Wu (2017)Xu, L., & Wu, L. (2017). Clinical observation of recombinant human endostatin combined with GP chemotherapy for advanced non-small cell lung cancer. Chinese Journal of Clinical Rational Drug Use, 10(13), 91-92.	P=0.99	I²=0	1.68(1.48, 1.91)	P<0.000 01
Song et al. (2018)Song, W. C., Bao, Y., & Qian, J. (2018). Study on clinical efficacy of endostar combined with gemcitabine and cisplatin in the treatment of advanced lung squamous cell carcinoma and effect on quality of life. The Practical Journal of Cancer, 33(1), 59-62.	P=0.99	I²=0	1.68(1.48, 1.90)	P<0.000 01
Wang (2018)Wang, Z. F. (2018). Effects of endo combined with first-line GP chemotherapy on survival time and quality of life in patients with advanced lung squamous cell carcinoma. Journal of Medical Theory and Practice, 31(2), 210-211.	P=0.99	I²=0	1.67(1.47, 1.89)	P<0.000 01
Zhong & Chen (2018)Zhong, L., & Chen, F. C. (2018). Efficacy and safety of Endostar combined with chemotherapy in the treatment of advanced non-small cell lung cancer. Chinese Manipulation & Rehabilitation Medicine, 9(2), 66-67.	P=0.99	I²=0	1.66(1.46, 1.88)	P<0.000 01

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[1] *Corresponding author: hsc@jlu.edu.cn