八种化疗方案治疗低危妊娠滋养细胞肿瘤Meta分析  

Eight chemotherapy regimens in treatment of low-risk gestational trophoblastic neoplasms:a meta-analysis

作　　者：李秋书 王赞宏[2] 任松洁 Li Qiushu;Wang Zanhong;Ren Songjie(Graduate School,Shanxi Medical University,Taiyuan 030001,China;Department of Obstetrics and Gynecology,Shanxi Bethune Hospital Affiliated to Shanxi Medical University,Taiyuan 030032,China)

机构地区：[1]山西医科大学研究生学院,太原030001 [2]山西医科大学附属山西白求恩医院妇产科,太原030032

出　　处：《肿瘤研究与临床》2020年第12期854-861,共8页Cancer Research and Clinic

基　　金：山西省科技成果转化引导专项(201604D132043)。

摘　　要：目的系统评价8种化疗方案治疗低危妊娠滋养细胞肿瘤的有效性及安全性。方法计算机检索PubMed、Cochrane图书馆、EMbase、Medline、万方、维普、中国知网等数据库,检索时限从建库至2019年10月,使用Stata 13.0绘制网状关系图,分别使用Revman 5.3和GeMTC软件进行直接和网状Meta分析。结果最终纳入13篇随机对照试验,共使用8种化疗方案。直接Meta分析显示,放线菌素D单日冲击方案初治完全缓解(PCR)率优于甲氨蝶呤单日冲击方案,差异具有统计学意义(OR=0.21,95%CI 0.08~0.55,P<0.05)。网状Meta分析显示,放线菌素D 5 d方案、甲氨蝶呤+放线菌素D方案PCR率优于甲氨蝶呤+叶酸8 d方案,差异均具有统计学意义(OR=0.11,95%CI 0.01~0.71;OR=0.03,95%CI 0.00~0.75,均P<0.05),放线菌素D单日冲击方案PCR率优于甲氨蝶呤单日冲击方案,差异具有统计学意义(OR=0.19,95%CI 0.04~0.79,P<0.05);甲氨蝶呤单日冲击方案、放线菌素D单日冲击方案中性粒细胞减少发生率低于甲氨蝶呤5 d方案,差异均具有统计学意义(OR>100,95%CI下限2.43,上限>100;OR>100,95%CI下限1.84,上限>100);甲氨蝶呤+叶酸8 d方案、甲氨蝶呤单日冲击方案、放线菌素D单日冲击方案血小板减少发生率均低于放线菌素D 5 d方案,差异均具有统计学意义(OR=0.00,95%CI 0.00~0.75;OR=0.00,95%CI 0.00~0.28,OR>100,95%CI下限1.35,上限>100,均P<0.05),甲氨蝶呤单日冲击方案、放线菌素D单日冲击方案低于甲氨蝶呤+放线菌素D方案,差异具有统计学意义(OR=0.00,95%CI 0.00~0.27;OR=0.00,95%CI 0.00~0.72)。概率排序图显示,有效性方面放线菌素D 5 d方案及甲氨蝶呤+放线菌素D方案更有优势;安全性方面甲氨蝶呤单日冲击方案、放线菌素D单日冲击方案效果更好。结论放线菌素D 5 d方案及甲氨蝶呤+放线菌素D方案具有较高的PCR率及较短的治疗周期,但其不良反应发生率如血小板减少也高于其他方案,仍需更多高质量、大样本研究�Objective To systematically evaluate the efficacy and safety of 8 chemotherapy regimens in treatment of low-risk gestational trophoblastic neoplasms.Methods PubMed,Cochrane library,EMbase,Medline,Wanfang,VIP and CNKI were retrieved by computer,and the retrieval period was from database establishing time to October 2019.Stata 13.0 was used to draw the mesh diagram.Revman 5.3 and GeMTC software were used for direct and network meta-analysis respectively.Results There were 13 randomized controlled trials and 8 chemotherapy regimens.Direct meta-analysis showed that the pathological complete remission(PCR)rate of pulsed actinomycin D(act-D)was better than that of pulsed methotrexate(MTX),and the difference was statistically significant(OR=0.21,95%CI 0.08-0.55,P<0.05).Network meta-analysis showed that the PCR rate of 5 d-act-D regimen and MTX+act-D regimen was better than that of MTX+folic acid,and the difference was statistically significant(OR=0.11,95%CI 0.01-0.71;OR=0.03,95%CI 0.00-0.75,all P<0.05);PCR rate of pulsedⅣact-D was better than that of pulsed MTX,and the difference was statistically significant(OR=0.19,95%CI 0.04-0.79,P<0.05).The incidence of neutropenia in pulsed MTX and pulsed act-D was lower than that in 5 d-MTX,and the differences were statistically significant(OR>100,95%CI 2.43->100;OR>100,95%CI 1.84->100).The incidence of thrombocytopenia in 8 d-MTX+folic acid,pulsed MTX and pulsed act-D was lower than that in 5 d-act-D,and the differences were statistically significant(OR=0.00,95%CI 0.00-0.75;OR=0.00,95%CI 0.00-0.28;OR>100,95%CI 1.35->100,all P<0.05).Pulsed MTX and pulsed act-D was lower than that in MTX+act-D,and the differences were statistically significant(OR=0.00,95%CI 0.00-0.27;OR=0.00,95%CI 0.00-0.72).The probability ranking diagram showed that 5 d-act-D and MTX+act-D had more advantages in terms of effectiveness;in terms of safety,pulsed MTX and pulsed act-D had better therapeutic effects.Conclusions MTX+act-D and 5 d-act-D have higher PCR rate and shorter treatment cycle.However,the inci

关 键 词：妊娠滋养细胞肿瘤 抗肿瘤联合化疗方案 META分析 

分 类 号：R737.33[医药卫生—肿瘤]