紫杉醇联合卡铂周疗和三周疗法治疗卵巢癌的Meta分析  

Efficacy and safety of paclitaxel and carboplatin for ovarian cancer:a Meta-analysis

作　　者：范淑英[1] 王健[1] 刘芸[1] 周宏萍[1] 董仙萍[1] 钱海利[2] 

机构地区：[1]唐山市开滦总医院,河北唐山063000 [2]中国医学科学院北京协和医学院肿瘤医院分子肿瘤学国家重点实验室,北京100021

出　　处：《解放军医学杂志》2016年第7期589-597,共9页Medical Journal of Chinese People's Liberation Army

摘　　要：目的系统评价紫杉醇联合卡铂周疗和三周疗法治疗卵巢癌的有效性及安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library（2016年第2期）、WHO国际临床试验注册平台（ICTRP）、CNKI、VIP和Wan Fang Data数据库,搜集每周与每三周紫杉醇联合卡铂化疗方案治疗卵巢癌的随机对照试验,检索时限均为从建库至2016年2月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入9个研究共2723例患者。Meta分析结果显示：与紫杉醇联合卡铂三周疗法比较,紫杉醇联合卡铂周疗能提高卵巢癌患者的总生存率（OS）（HR=0.85,95%CI 0.73~0.98,P=0.03）,但在治疗有效率（OR=1.13,95%CI 0.91~1.39,P=0.27）、生存率（OR=1.10,95%CI 0.99~1.22,P=0.07）和无进展生存期（PFS）（HR=0.89,95%CI0.74~1.06,P=0.18）方面两组差异无统计学意义。在安全性方面,紫杉醇联合卡铂周疗组血液系统的不良反应高于三周疗组,差异有统计学意义（OR=1.68,95%CI 1.20~2.36,P=0.003）。紫杉醇联合卡铂周疗组在导致呕吐（OR=0.67,95%CI 0.54~0.83,P=0.0002）、脱发（OR=0.57,95%CI 0.44~0.74,P〈0.0001）方面低于三周疗组,差异均有统计学意义,但在肝功能异常（OR=1.30,95%CI 0.88~1.90,P=0.19）、肾功能异常（OR=1.07,95%CI 0.65~1.77,P=0.79）、感觉异常（OR=1.13,95%CI 0.91~1.41,P=0.26）、心电图异常（OR=0.74,95%CI 0.35~1.58,P=0.44）等方面两组差异均无统计学意义。结论紫杉醇联合卡铂周疗可改提高卵巢癌患者的OS,降低呕吐、脱发发生率,在治疗有效率、生存率、PFS、肝功能异常、肾功能异常、感觉异常和心电图异常等方面与三周疗法无明显差异。但每周治疗组的血液系统不良反应高于每三周治疗组。Objective To systematically evaluate the efficacy and safety of paclitaxel and carboplatin dose-dense weekly compared with the same chemotherapeutics administered every 3 weeks for ovarian cancer.Methods The databases,including Pub Med,EMbase,The Cochrane Librar y（Issue 2,2016）,WHO ICTRP,CNKI,VIP and Wan Fang Data,were electronically searched from inception to February 2016 to collect the randomized controlled trials（RCTs） about dose-dense weekly paclitaxel and carboplatin vs paclitaxel and carboplatin administered every 3 weeks for ovarian cancer.According to the inclusion and exclusion criteria,two reviewers independently screened literatures,extracted data and assessed the risk of bias of included studies,and then meta-analysis was conducted by Rev Man5.3 software.Results A total of 9 studies involving 2723 patients were included.The results of meta-analysis showed that,compared with the conventional treatment group,the dose-dense treatment group could significantly prolong the OS（Overall survival）（HR=0.85,95%CI 0.73-0.98,P=0.03）,but no significant difference existed between the two groups in clinical response（OR=1.13,95%CI 0.91-1.39,P=0.27）,survival（OR=1.10,95%CI 0.99-1.22,P=0.07） and PFS（progression-free survival）（HR=0.89,95%CI 0.74-1.06,P=0.18）.A significantly higher blood system adverse reaction rate was in dose-dense treatment group than in conventional treatment group（OR=1.68,95%CI 1.20-2.36,P=0.003）;however,significantly lower rates of vomiting（OR=0.67,95%CI 0.54-0.83） and hair loss（OR=0.57,95%CI 0.44-0.74,P〈0.0001） were in dose-dense treatment group.There were no significant difference existed between the two groups in liver function（OR=1.30,95%CI 0.88-1.90,P=0.19）,kidney function（OR=1.07,95%CI 0.65-1.77,P=0.79）,paresthesia（OR=1.13,95%CI 0.91-1.41,P=0.26） and ECG（OR=0.74,95%CI 0.35-1.58,P=0.44）.Conclusions Current evidences have shown that dose-dense weekly paclitaxel and carboplatin can prolong the OS,lower the rates of vomiting and hair lo

关 键 词：紫杉醇 卡铂 卵巢肿瘤 META分析 

分 类 号：R733.712[医药卫生—肿瘤]