贝伐单抗联合紫杉类化疗方案治疗HER-2阴性转移性乳腺癌的疗效评估:一项Meta分析  

Bevacizumab combined with taxanes chemotherapy for HER-2 negative metastatic breast cancer:A Meta-analysis

作　　者：韩晓刚 孟庆杰 刘向华 印玉龙 张达 赵昕辉 吕勇刚 HAN Xiaogang;MENG Qingjie;LIU Xianghua;YIN Yulong;ZHANG Da;ZHAO Xinhui;LYU Yonggang(Department of Thyroid and Breast Surgery,Xi'an No.3 Hospital,the Affiliated Hospital of Northwest University,Shaanxi Xi'an 710018,China;General Surgery Department,Xi'an No.3 Hospital,the Affiliated Hospital of Northwest University,Shaanxi Xi'an 710018,China)

机构地区：[1]西北大学附属医院/西安市第三医院甲乳外科,陕西西安710018 [2]西北大学附属医院/西安市第三医院普外科,陕西西安710018

出　　处：《现代肿瘤医学》2022年第7期1218-1223,共6页Journal of Modern Oncology

基　　金：陕西省西安市科学技术局科技计划项目(编号:2019115213YX007SF040);陕西省西安市卫生和计划生育委员会卫生科研人才项目(编号:J201902045)。

摘　　要：目的:采用Meta分析方法系统性评估贝伐单抗联合紫杉类化疗药物对HER-2阴性转移性乳腺癌的治疗效果。方法:电子计算机检索自建库至2020年12月发表的有关贝伐单抗联合紫杉类药物治疗HER-2阴性转移性乳腺癌的文章。根据制定的纳入和排除标准对文献进行筛选以及质量评价,然后提取研究数据。选择PFS、OS、ORR以及1年生存率(1y SR)作为主要疗效结局指标,采用Stata软件对合并效应量风险比率(hazard ratio,HR)和相对危险度(relative ratio,RR)进行Meta合并分析,按照研究类型进行亚组分析。发表偏倚利用漏斗图法以及Egger检验进行定性和定量评估。结果:初检文献849篇,最终纳入9篇文献进入Meta分析,研究共包含患者6242例,其中贝伐单抗联合紫杉组3555例,紫杉单药组2687例。文献质量评价均为中等或高等质量。Meta合并结果显示,贝伐单抗联合紫杉方案对比紫杉单药能够显著提升PFS(HR=0.65,95%CI 0.55~0.77,Z=5.01,P<0.001)、ORR(RR=1.59,95%CI 1.44~11.74,Z=9.61,P<0.001)以及1y SR(RR=1.11,95%CI 1.08~1.15,Z=6.26,P<0.001),但在OS方面的优势不具有显著统计学意义(HR=0.83,95%CI 0.69~1.00,Z=2.0,P<0.045)。结论:贝伐单抗联合紫杉类治疗方案,相比紫杉单药化疗方案可以明显提升PFS、ORR以及1年生存率,但并不能显著增加OS。因此,在临床实践中,应当谨慎为患者选择治疗方案。Objective:To systematically evaluate the efficacy of bevacizumab combined with taxanes in the treatment of HER-2-negative metastatic breast cancer using a meta-analysis method.Methods:Articles about bevacizumab combined with taxanes in the treatment of HER-2-negative metastatic breast cancer published in databases from database establishment to December 2020 were searched.According to the inclusion and exclusion criteria,literatures were screened and the quality was evaluated,and then data was extracted.PFS,OS,ORR and 1-year survival rate(1y SR)were selected as the main efficacy outcome indicators,and the hazard ratio(HR)and relative ratio(RR)were meta-analyzed using Stata software,and subgroup analysis was performed according to study type.The publication bias was evaluated qualitatively and quantitatively by funnel plot method and Egger test.Results:849 articles were identified and 9 articles were finally included.A total of 6242 patients were included in this study,including 3555 patients in the combined therapy group and 2687 patients in the monotherapy group.All the literature quality evaluations were of medium or high quality.Meta-pooled results showed that bevacizumab combined with taxane could significantly improve PFS(HR=0.65,95%CI 0.55~0.77,Z=5.01,P<0.001),ORR(RR=1.59,95%CI 1.44~1.74,Z=9.61,P<0.001)and 1y SR(RR=1.11,95%CI 1.08~1.15,Z=6.26,P<0.001)compared with taxane alone,but there was no significant difference in OS(HR=0.83,95%CI 0.69~1.00,Z=2.0,P<0.045).Conclusion:Bevacizumab combined with taxane therapy significantly improved PFS,ORR and 1-year survival compared to taxane chemotherapy alone,but did not significantly increase OS.Therefore,patients should be carefully selected in clinical practice.

关 键 词：HER-2 乳腺癌 贝伐单抗 紫杉类 

分 类 号：R737.9[医药卫生—肿瘤]