TACE联合抗血管生成药治疗不可切除PLC有效性和安全性的网状Meta分析  

Network meta-analysis for efficacy and safety of TACE combined with anti-angiogenic drugs in the treatment of unresectable primary liver cancer

作　　者：卢芬萍 邢光艳 刘博文 李晓斌 赵凯 冉云[1] 吴芬芳 胡世平 LU Fenping;XING Guangyan;LIU Bowen;LI Xiaobin;ZHAO Kai;RAN Yun;WU Fenfang;HU Shiping(Shenzhen Hospital,Beijing University of Chinese Medicine,Guangdong Shenzhen 518172,China;Beijing University of Chinese Medicine,Beijing 100029,China;Dept.of Nephrology,Shaanxi Sunshine Chinese Medical Hospital for Liver and Kidney Disease,Xi’an 710016,China)

机构地区：[1]北京中医药大学深圳医院,广东深圳518172 [2]北京中医药大学,北京100029 [3]陕西双博中医肝肾病医院肾病科,西安710016

出　　处：《中国药房》2024年第20期2533-2540,共8页China Pharmacy

基　　金：国家自然科学基金面上项目(No.81973733);深圳市“医疗卫生三名工程”资助项目(No.SZZYSM202311018);深圳市龙岗区科技创新专项资金医疗卫生技术攻关项目(No.LGKCYLWS2022006);深圳市龙岗区肝病多层次信息化数据平台及中西医管理中心建设项目(No.LGKCYL-WS2021000015)。

摘　　要：目的系统评价经动脉化疗栓塞术(TACE)联合抗血管生成药治疗不可切除原发性肝癌(PLC)的有效性和安全性。方法检索中国知网、the Cochrane Library等中英文数据库和Google、百度学术,收集TACE联合抗血管生成药治疗不可切除PLC的随机对照试验(RCT),检索时限均为建库至2024年5月27日。筛选文献、提取资料、评价文献质量后,采用R 4.2.2和Stata 17.0软件进行网状Meta分析。结果共纳入44项RCT,共计5607例患者,涉及8种干预措施。网状Meta分析结果显示,在延长中位总生存期(mOS)、中位无进展生存期(m PFS)方面,以TACE+阿帕替尼疗效最优,网状Meta排序前2位的为TACE+阿帕替尼、TACE+索拉非尼;在提高客观缓解率(ORR)和疾病控制率(DCR)方面,以TACE+多纳非尼疗效最优,网状Meta排序前2位的为TACE+多纳非尼、TACE+仑伐替尼;安全性方面,以TACE+多纳非尼最优,网状Meta排序前2位的为TACE+多纳非尼、TACE+阿帕替尼。结论TACE+阿帕替尼、TACE+多纳非尼用于不可切除PLC患者的疗效均较好,且以TACE+多纳非尼的安全性最优。OBJECTIVE To systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with anti-angiogenic drugs for the treatment of unresectable primary liver cancer(PLC).METHODS Retrieved from Chinese and English databases such as CNKI,the Cochrane Library,Google,and Baidu Academic,randomized controlled trial(RCT)about TACE combined with anti-angiogenic drugs for the treatment of unresectable PLC were collected from the inception to May 27,2024.After screening the literature,extracting data,and evaluating the quality of the literature,network meta-analysis was performed using R 4.2.2 and Stata 17.0.RESULTS A total of 44 RCT were included,involving 5607 patients and 8 interventions.The network meta-analysis results showed that for prolonging median overall survival(mOS)and median progression-free survival(mPFS),TACE+apatinib had the best efficacy,with TACE+apatinib and TACE+sorafenib ranking as the top two.For improving objective response rate(ORR)and disease control rate(DCR),TACE+donafenib had the best efficacy,with TACE+donafenib and TACE+lenvatinib ranking as the top two.In terms of safety,TACE+donafenib was the best,with TACE+donafenib and TACE+apatinib ranking as the top two.CONCLUSIONS TACE+apatinib and TACE+donafenib have good efficacy for patients with unresectable PLC,and TACE+donafenib has the best safety profile.

关 键 词：原发性肝癌 不可切除 经动脉化疗栓塞术 抗血管生成药 TACE 网状Meta分析 

分 类 号：R735.7[医药卫生—肿瘤] R979.1[医药卫生—临床医学]