靶向治疗药物在转移性非透明细胞肾癌患者中应用效果的Meta分析  

Efficacy of targeted drugs for metastatic non-clear cell renal cell carcinoma:a Meta-analysis

作　　者：张瑞[1,2] 郑昱 侯广东 高继学 王福利[2] ZHANG Rui;ZHENG Yu;HOU Guangdong;GAO Jixue;WANG Fuli(Medical College of Yan an University,Yan an 716000;Department of Urology,First Affiliated Hospital,Air Force Medical University,Xi an 710032;Military Medical Innovation Center,Air Force Medical University,Xi an 710032;Department of Urology,Affiliated Hospital of Yan an University,Yan an 716000,China)

机构地区：[1]延安大学医学院,陕西延安716000 [2]空军军医大学第一附属医院泌尿外科 [3]空军军医大学军事医学创新中心,陕西西安710032 [4]延安大学附属医院泌尿外科,陕西延安716000

出　　处：《现代泌尿外科杂志》2023年第5期394-403,共10页Journal of Modern Urology

摘　　要：目的系统评价靶向药物治疗转移性非透明细胞肾癌(nccRCC)患者的疗效和安全性,为临床治疗nccRCC提供指导。方法计算机检索2006年1月-2022年7月PubMed、Embase、Cochrane Library、web of science数据库中所有关于靶向药物治疗nccRCC患者的观察性研究和随机对照试验,由3名独立研究者筛选文献、提取数据及评价文献质量,RCT研究使用Cochrane系统评价手册进行评估,只有一项研究结局数据不完整(随访偏倚)被评估为高风险,其余为低风险和不确定风险,非RCT研究经JBI质量评价工具评估,所有研究均显示偏倚风险低。使用Stata.17软件对结果进行Meta分析。结果共纳入16项研究,涉及989例患者。Meta分析结果显示,靶向药物治疗转移性nccRCC患者的总客观缓解率(ORR)为12.6%(95%CI:8.1%~17.9%),总疾病控制率(DCR)为65.3%(95%CI:58.3%~72.1%),总中位无进展生存期(PFS)为5.80(95%CI:4.69~6.91)个月,总中位总生存期(OS)为15.93(95%CI:12.17~19.68)个月。亚组分析中:舒尼替尼及卡博替尼治疗转移性nccRCC患者的总ORR分别为11.7%(95%CI:6.5%~18.0%)和17.2%(95%CI:8.4%~28.2%),乳头状肾细胞癌患者的总ORR为9.1%(95%CI:2.4%~18.9%)。结论靶向药物对于转移性nccRCC患者疗效显著,但患者可能会发生不良反应,其中转移性乳头状肾细胞癌效果较差,卡博替尼能使患者生存获益更大。Objective To systematically evaluate the efficacy and safety of targeted drugs in the treatment of metastatic non-clear cell renal cell carcinoma(nccRCC)and to provide guidance for clinical treatment.Methods All observational studies and randomized controlled trials(RCTs)of nccRCC treated with targeted drugs were retrieved from the PubMed,Embase,the Cochrane Library and Web of Science.Three independent investigators screened the literature,extracted data and evaluated the quality of literature.The RCTs were evaluated using the Cochrane Handbook.One research with insufficient outcome data(follow-up bias)was assessed as high risk,and the other studies showed low or uncertain risk.The non-RCTs were evaluated with the JBI Quality Assessment Tool,and all studies displayed a low risk of bias.The data were analyzed with Stata 17.0 software.Results A total of 16 studies involving 989 patients were included.Meta-analysis showed that the objective response rate(ORR)was 12.6%(95%CI:8.1%-17.9%),the total disease control rate(DCR)was 65.3%(95%CI:58.3%-72.1%),the total median progression-free survival(PFS)was 5.80(95%CI:4.69-6.91)months,and the median overall survival(OS)was 15.93(95%CI:12.17-19.68)months.In subgroup analysis,the total ORR of patients with metastatic nccRCC treated with sunitinib and cabozantinib were 11.7%(95%CI:6.5%-18.0%)and 17.2%(95%CI:8.4%-28.2%),respectively.The total ORR of patients with papillary renal cell carcinoma was 9.1%(95%CI:2.4%-18.9%).Conclusion Targeted drugs have a significant effect on patients with metastatic nccRCC,but adverse reactions may occur.Targeted drugs have poor effects on metastatic papillary renal cell carcinoma,and cabozantinib may have greater survival benefits.

关 键 词：非透明细胞肾癌 靶向治疗 不良反应 治疗效果 转移性肾癌 舒尼替尼 卡博替尼 

分 类 号：R737.1[医药卫生—肿瘤]