肿瘤电场治疗及血管抑制剂联合Stupp治疗新诊断胶质母细胞瘤有效性及安全性的网状Meta分析  

Efficacy and Safety of Tumor-treating Fields Versus Angiogenesis Inhibitors in Combination with Stupp Protocol for Newly Diagnosed Glioblastoma:a Network Meta-analysis

作　　者：苏东坡 左正瑶 李梅 韩仟 张卫红 付爱军 朱军 陈通 SU Dongpo;ZUO Zhengyao;LI Mei;HAN Qian;ZHANG Weihong;FU Aijun;ZHU Jun;CHEN Tong(Department of Neurosurgery,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China;Department of Nursing,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院神经外科,河北省唐山市063000 [2]华北理工大学附属医院护理部,河北省唐山市063000

出　　处：《中国全科医学》2021年第29期3751-3756,共6页Chinese General Practice

基　　金：河北省“三三三人才工程”资助项目(202002006)。

摘　　要：背景肿瘤电场治疗(TTFields)和血管抑制剂联合Stupp,在治疗新诊断胶质瘤方面均取得了较好的效果,但目前关于两者之间直接对比结果的研究较少。目的探究在新诊断胶质母细胞瘤患者中,TTFields及血管抑制剂联合Stupp的有效性及安全性。方法全面检索PubMed、The Cochrane Library、EMBase、OVID数据库,检索时间为2004-01-01至2020-01-01。采用Excel软件提取文献信息,信息包括:第一作者、国家、发表年份、纳入患者例数、年龄、治疗方案(试验组:贝伐珠单抗、西仑吉肽、TTFields联合其他治疗方案;对照组:Stupp)、结局指标〔总生存期(OS)、无进展生存期(PFS)〕以及不良事件发生情况等。对纳入文献进行质量评估并采用RevMan 5.3和Stata 13.1统计软件进行网状Meta分析。结果本研究共纳入7篇文献,文献质量均较高,其中试验组纳入患者1859例、对照组纳入患者1566例。网状图中包括7种不同的治疗方案:TTFields联合替莫唑胺(TTFields+Stupp)、贝伐珠单抗联合替莫唑胺(Bev+Stupp)、贝伐珠单抗联合伊立替康(Bev+Iri)、贝伐珠单抗联合伊立替康再联合替莫唑胺(Bev+Iri+Stupp)、西仑吉肽联合替莫唑胺(Cilengitide 2次/周+Stupp)、西仑吉肽联合替莫唑胺(Cilengitide 5次/周+Stupp)和替莫唑胺(Stupp)。通过网状Meta分析,发现各治疗方案6个月OS从高到低排序依次是:TTFields+Stupp>Cliengitide 5次/周+Stupp>Bev+Stupp>Cliengitide 2次/周+Stupp>Bev+Iri+Stupp>Bev+Iri>Stupp;1年OS从高到低排序依次是:TTFields+Stupp>Bev+Iri>Bev+Stupp>Cliengitide 2次/周+Stupp>Cliengitide 5次/周+Stupp>Bev+Iri+Stupp>Stupp;6个月PFS从高到低排序依次是:Bev+Iri>Bev+Stupp>TTFields+Stupp>Bev+Iri+Stupp>Cliengitide 5次/周+Stupp>Cliengitide 2次/周+Stupp>Stupp;1年PFS从高到低排序依次是:Bev+Iri>Bev+Stupp>Bev+Iri+Stupp>TTFields+Stupp>Cliengitide 2次/周+Stupp>Cliengitide 5次/周+Stupp>Stupp。不良事件方面:贝伐珠单抗和伊立替康增加了患者�Background Tumor-treating fields(TTFields)with Stupp protocol and angiogenesis inhibitors with Stupp protocol have proved to be effective in the treatment of newly diagnosed glioblastoma,but there are few studies directly comparing their efficacies and safety.Objective To compare the efficacy and safety of TTFields versus angiogenesis inhibitors in combination with Stupp protocol for newly diagnosed glioblastoma.Methods The databases of PubMed,The Cochrane Library,EMBase and OVID were comprehensively searched from January 1,2004 to January 1,2020 for studies about newly diagnosed glioblastoma treated by TTFields with Stupp protocol compared with those treated by angiogenesis inhibitors with Stupp protocol.The literature information was extracted and stored in the Excel file,including the first author,country of the author,year of publication,number and age of participants,treatment scheme(experimental groups:Stupp protocol in combination with bevacizumab,cilengitide,or TTFields combined with other treatment regimens;control group:Stupp protocol),outcome indicators〔overall survival(OS),progression-free survival(PFS)〕and adverse events.The quality of the included literatures was evaluated.Revman 5.3 and Stata 13.1 were used for network meta-analysis.Results Seven studies were included,involving 1859 cases and 1566 controls,with a relatively high methodological quality.Seven therapies from studies were included in the network meta-analysis:TTFields with Stupp protocol,bevacizumab with Stupp protocol,bevacizumab with irinotecan,bevacizumab with irinotecan and Stupp protocol,cilengitide(twice a week)with Stupp protocol,cilengitide(five times a week)with Stupp protocol,and Stupp protocol.Through network meta-analysis,the 6-month OS rate of each treatment modality was ranked from high to low:TTFields with Stupp protocol>cliengitide(five times a week)with Stupp protocol>bevacizumab with Stupp protocol>cliengitide(twice a week)with Stupp protocol>bevacizumab with irinotecan and Stupp protocol>bevacizumab with irinotec

关 键 词：胶质母细胞瘤 肿瘤电场治疗 替莫唑胺 贝伐珠单抗 西仑吉肽 网状Meta分析 诊断 有效性 安全性 生存情况 

分 类 号：R730.264[医药卫生—肿瘤]