贝伐单抗治疗卵巢癌疗效及不良反应的系统评价  

Adverse events risk associated with bevacizumab for ovarian cancer: a systematic review

作　　者：陈小芸[1] 张栋栋[1] 范维[1] 郭钰珍[1] 

机构地区：[1]兰州大学第二医院妇产科,兰州730030

出　　处：《现代妇产科进展》2014年第7期548-552,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:系统评价贝伐单抗治疗卵巢癌患者的疗效及不良反应,探讨贝伐单抗在卵巢癌治疗中的应用价值。方法:全面检索Medline、EMbase、PubMed、Cochrane Library、Web of Science、CNKI、CBM、VIP及万方等数据库,并查阅相关领域的杂志。检索时限截至2013年11月。由两名独立研究者根据纳入及排除标准以及Cochrane Handbook5.0的质量评价标准筛选文献,评价纳入研究的文献质量,并提取有效数据采用Review Manager 5.2软件进行Meta分析。结果:经筛选,共纳入5篇研究,4218例患者。结果显示,联合贝伐单抗治疗组能明显地增加患者的中位无进展生存时间,但中位生存时间之间差异无统计学意义。Meta结果显示,联合贝伐单抗治疗组的高血压[OR=3.73,95%CI(2.04,6.82),P<0.0001]、蛋白尿[OR=2.96,95%CI(1.13,7.75),P=0.03]、出血症状[OR=4.57,95%CI(3.58,5.84),P<0.00001]及伤口愈合并发症[OR=1.59,95%CI(1.11,2.28),P=0.01]等不良反应发生率较高,差异显著;两组的肠穿孔、肠脓肿及瘘、充血性心力衰竭、中性粒细胞减少、动脉和静脉血栓形成及可逆性后部白质脑病综合征(RPLS)不良反应的发生率无统计学差异。结论:贝伐单抗联合标准化疗能增加不良反应发生的风险,受研究质量及数量的限制,上述结论需更多高质量随机对照试验进一步证实。Objective：To assess the effectiveness and safety of bevacizumab for ovarian cancer and explore the value of its clinical use. Methods：The database such as Medline、EM-base、PubMed、Cochrane Library、Web of Science、CNKI、CBM、VIP and WanFang Data were searched for randomized controlled trial（RCTs）from inception to Nov. 2013. And relevant mag-azine were also selected. Two reviewers independently screened literature according to the inclu-sion and exclusion criteria as well as the methods recommended by the Cochrane Handbook 5 . 0,extracted efficient data and assessed the methodological quality of the included studies. Then, the meta-analysis was performed using RevMan 5. 2 software. Results：A total of 5 RCTs invol-ving 4243 patients were included. The results showed that,there were significant difference in median progression free survival and no difference between the two groups in median overall survival. When taking safety into consideration bevacizumab can significantly increase the rate of hypertension（OR=3. 73,95%CI 2. 04 to 6. 82,P＆lt;0. 0001）,proteinuria（OR=2. 96,95%CI 1. 13 to 7. 75,P=0. 03）,bleeding（OR=4. 57,95%CI 3. 58 to 5. 84）,P＆lt;0. 00001）,compli-cation of wound healing （OR=1. 59,95%CI 1. 11 to 2. 28,P=0. 01）in this meta-analysis. But no significant difference was found in the incidence of gastrointestinal perforation,abscess and fistula,congestive heart failure,arterial and venous thromboembolic event and RPLS. Conclu-sion：Bevacizumab can obviously increase the incidence of adverse reaction of ovarian cancer, such as hypertension,proteinuria,bleeding,complication of wound healing. For the limitation of quality and quantity of included studies,this conclusion still needs to be proved by con-ducting more high quality researches.

关 键 词：卵巢癌 贝伐单抗 随机对照试验 系统评价 META-分析 

分 类 号：R737.31[医药卫生—肿瘤]