远处转移性肾癌患者术后辅助靶向治疗疗效和安全性的Meta分析  

Efficacy and safety of adjuvant targeted therapy for patients with non-distant metastasis renal cell carcinoma

作　　者：郑昱[1] 魏迪[1] 侯广东 张更[1] 袁建林[1] Zheng Yu;Wei Di;Hou Guangdong;Zhang Geng;Yuan Jianlin(Department of Urology,Xijing Hospital,Fourth Military Medical University,Xi′an 710032,China)

机构地区：[1]第四军医大学西京医院泌尿外科,西安710032

出　　处：《中华泌尿外科杂志》2019年第3期171-177,共7页Chinese Journal of Urology

摘　　要：目的评价无远处转移性肾癌患者术后辅助靶向治疗的疗效及不良反应。方法通过计算机从PubMed、SpringerLink、Web of Science及Cochrane Library数据库中检索2006年1月1日至2018年12月10日所有关于无远处转移性肾癌患者术后辅助靶向治疗的临床随机对照试验文献资料,由3名研究者独立进行文献筛选、数据提取及文献质量评价,使用Review Manager Version 5.3软件进行Meta分析。对比术后辅助靶向治疗组与安慰剂对照组患者的无肿瘤进展生存期、总生存期及不良反应发生情况。结果4项随机对照试验中的5组研究被纳入Meta分析,共包含4 944例无远处转移性肾癌患者。术后辅助靶向治疗能够提高患者的无肿瘤进展生存期,与安慰剂对照组比较,风险比为0.92(95%CI0.85~1.00,P=0.05);并且随着随访时间的延长,这种效应更加显著,风险比为0.89(95%CI0.81~0.97,P=0.01)。但术后辅助靶向治疗并不能提高患者的总生存期,与安慰剂对照组比较,风险比为0.92(95%CI0.81~1.05,P=0.22)。与安慰剂对照组比较,术后辅助靶向治疗增加了患者的不良反应和因为不良反应而停药的发生率,比值比分别为6.03(95%CI5.30~6.86,P<0.001)和7.65(95%CI6.31~9.26,P<0.001)。结论术后辅助靶向治疗能提高无远处转移性肾癌患者的无肿瘤进展生存期,但不能够提高患者的总生存期,并且增加了患者不良反应的发生率。Objective To evaluate the efficacy and adverse events of adjuvant targeted therapy for non-distant metastatic renal cell carcinoma(ndmRCC).Methods A comprehensive literature search was conducted in PubMed,SpringerLink,Web of Science,and the Cochrane Library.All clinical randomized controlled trials on adjuvant targeting therapy for ndmRCC were retrieved.Literature screening,data extraction and literature quality evaluation were conducted by three researchers independently,and meta-analysis was performed using Review Manager Version 5.3.Outcomes we were interested in included progression-free survival(PFS),overall survival(OS),and adverse events.Results A total of 4 RCTs with 5 studies and 4 944 ndmRCC patients were selected for meta-analysis.Targeted adjuvant therapy improved the PFS of ndmRCC patients.The hazard ratio(HR)was 0.92(95%CI0.85-1.00,P=0.05)between the targeted therapy group and the placebo group.With the extension of follow-up,this effect was more significant,and the HR was 0.89(95%CI0.81-0.97,P=0.01).However,targeted adjuvant therapy did not extend the OS of ndmRCC patients,and the HR was 0.92(95%CI0.81-1.05,P=0.22).Compared with the placebo,targeted adjuvant therapy increased the incidence of adverse events and the number of patients who had to discontinue because of adverse events was also increased.The odds ratios were 6.03(95%CI5.30-6.86,P<0.001)and 7.65(95%CI6.31-9.26,P<0.001),respectively.Conclusions Targeted adjuvant therapy can improve the PFS of ndmRCC patients after surgery,but it cannot improve the OS.At the same time,it increases the incidence of adverse events.

关 键 词：肾癌 术后辅助靶向治疗 META分析 

分 类 号：R737.11[医药卫生—肿瘤]