非肌层浸润性膀胱肿瘤热灌注化疗有效性和安全性的网状Meta分析  

Efficacy and safety of hyperthermic intravesical chemotherapy for non-muscle-invasive bladder cancer:a network meta-analysis

作　　者：白描 李涛[2] 周思辰 刘颖 刘玉慧 BAI Miao;LI Tao;ZHOU Si-chen;LIU Ying;LIU Yu-hui(Pharmaceutical Department,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,Shaanxi,CHINA;Department of Urology,Chang'an District Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710000,Shaanxi,CHINA)

机构地区：[1]陕西省核工业二一五医院药学部,陕西咸阳712000 [2]西安交通大学第一附属医院长安区医院泌尿外科,陕西西安710000

出　　处：《海南医学》2023年第17期2559-2566,共8页Hainan Medical Journal

摘　　要：目的系统评价非肌层浸润性膀胱肿瘤(NMIBC)经尿道术后行热灌注化疗(HIVEC)的有效性和安全性。方法计算机检索Pubmed、Embase、Cochrane Library、Web of Science、CNKI、VIP及CBM,检索时间均从建库截止2022年7月,由两名研究者独立筛选文献,收集NMIBC行HIVEC治疗的随机对照或临床对照试验,应用Revman 5.3、Stata 15.1软件和Ge MTC 0.14.3软件进行网状Meta分析。结果共纳入27篇文献,共2815例患者,包含HIVEC药物有丝裂霉素(HMMC)、吉西他滨(HG)、吡柔比星(HTHP)、表柔比星(HEPI)4种。网状Meta分析结果显示:在有效性方面,不同药物HIVEC均能改善NMIBC经尿道术后1年[常规灌注>HEPI>HTHP>HMMC>HG]和2年及以上[常规灌注>HMMC>HTHP>HG]复发率,其中以吉西他滨效果最佳。在安全性方面,HTHP、HMMC不良反应发生可能性增加,以吉西他滨安全性最好[HTHP>HMMC>常规灌注>HEPI>HG]。结论现有证据表明,不同药物HIVEC治疗均能降低NMIBC患者的1年和2年及以上肿瘤复发率,以吉西他滨效果最佳。同时,吡柔比星和丝裂霉素HIVEC后毒副作用随之增加,临床上应谨慎选择。受纳入研究质量的限制,本结论仍需后续研究进一步证实。Objective To systematically review the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)for non-muscle-invasive bladder cancer(NMIBC)after transurethral resection(TUR).Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,VIP,and CBM databases were electronically searched to collect randomized controlled trials or clinical controlled trials of HIVEC after TUR for NMIBC from inception to July 2022.Two reviewers independently screened literature,and the efficacy and safety were evaluated.Then,meta-analysis was performed using RevMan 5.3,Stata 15.1,and GeMTC 0.14.3 software.Results A total of 27 studies involving 2815 patients were included,and there were four medicines for HIVEC,including mitomycin,gemcitabine,pirarubicin,epirubicin.Network meta-analysis showed that each medicine could improve the recurrence rate of NMIBC at 1 year[conventional irrigation>epirubicin>pirarubicin>mitomycin>gemcitabine]and 2 years[conventional irrigation>mitomycin>pirarubicin>gemcitabine]after TUR in terms of effectiveness.And gemcitabine had the best effectiveness.In terms of safety,the possibility of adverse events after HIVEC with pirarubicin and mitomycin increased[pirarubicin>mitomycin>conventional irrigation>epirubicin>gemcitabine],and gemcitabine had the lowest adverse events rate.Conclusion Current evidence shows that all the 4 medicines for HIVEC could reduce the recurrence rate of NMIBC at 1 year and 2 years or more,and gemcitabine has the best effectiveness.However,pirarubicin and mitomycin for HIVEC increased the side effects rate,which should be carefully selected in clinical practice.Due to the limited quality of included studies,more high-quality studies are needed to verify the above conclusion.

关 键 词：非肌层浸润性膀胱肿瘤 膀胱肿瘤 热灌注化疗 网状Meta分析 

分 类 号：R737.14[医药卫生—肿瘤]