西妥昔单抗治疗头颈部进展期鳞癌的疗效和安全性的Meta分析  

Meta-Analysis of Cetuximab for Advanced Head and Neck Squamous Cell Carcinoma

作　　者：杨兴缨 李平[1] 肖吉元[1] 焦海胜[1] 

机构地区：[1]兰州大学第二医院药剂科,兰州730030

出　　处：《循证医学》2015年第5期289-294,共6页The Journal of Evidence-Based Medicine

摘　　要：目的系统评价西妥昔单抗治疗头颈部进展期鳞癌的有效性和安全性。方法全面检索Pub Med、EMBASE、Cochrane图书馆、OVID、CBM、CNKI、维普和万方数据库,采用Cochrane handbook推荐方法进行质量评价,使用Rev Man 5.0进行合并分析。结果纳入6项研究,共2 061例患者,Meta分析显示西妥昔单抗可显著提高患者的总生存期[风险比0.8,95%可信区间(0.7,0.92)]和无进展生存期[风险比0.72,95%可信区间(0.55,0.94)],同时提高治疗的有效率[相对危险度1.65,95%可信区间(1.0,2.73)]和控制率[相对危险度1.44,95%可信区间(1.06,1.98)],但增加了一些不良反应如痤疮样皮疹、输液反应、低镁血症、脓毒血症、厌食和黏膜炎的风险。结论西妥昔单抗可改善头颈部进展期鳞癌患者的总生存期和无进展生存期,提高治疗有效率和疾病控制率,不引起严重的不良反应,此结论仍需大样本、高质量的临床试验进一步支持。Objective Systematically review the efficacy and safety of Cetuximab for advanced head and neck squamous cell carcinoma（NHSCC）.Methods Databases including Pub Med,EMBASE,Cochrane Library,OVID,CBM,CNKI,VIP and Wanfang were comprehensively searched.We conducted quality assessment using the method recommended by Cochrane handbook and pooled analysis using Rev Man 5.0.Result Six trials with 2 061 patients were included.Compared with controlment,Cetuximab combined therapy decreased risk of disease progression [HR=0.72,95%CI（0.55,0.94）] and death [HR=0.8,95%CI（0.7,0.92）],and improved response rate [RR=1.65,95%CI（1.0,2.73）] and disease control rate [RR=1.44,95%CI（1.06,1.98）].Meanwhile,in terms of safety,significant differences were found in aspects of acne-like rash,infusion reaction,hypomagnesemia,sepsis,anorexia,and mucositis.Conclusion Regardless of serious and uncontrollable adverse event,Cetuximab could improve OS,PFS,response rate and disease control of HNSCC patients.While clinical trials with large samples and high quality are still warranted to support this conclusion.

关 键 词：头颈部肿瘤 鳞状细胞癌 西妥昔单抗 META分析 

分 类 号：R739.91[医药卫生—肿瘤]