血管生成抑制剂和PARP抑制剂治疗复发性卵巢癌有效性评价的网状meta分析  

Mesh meta-analysis of the effectiveness evaluation of angiogenesis inhibitors and poly ADP-ribose polymerase inhibitors in the treatment of recurrent ovarian cancer

作　　者：苏秋源 谭佳佳 赵玲 况燕[1,2] Su Qiuyuan;Tan Jiajia;Zhao Ling;Kuang Yan(Department of Gynecology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Gynecology,Guangzhou First people′s Hospital,Guangzhou 510180,China)

机构地区：[1]广西医科大学第一附属医院妇科,南宁530021 [2]广州市第一人民医院妇科,广州510180

出　　处：《中国医师杂志》2025年第1期11-17,共7页Journal of Chinese Physician

基　　金：国家自然科学基金(82260566,81960466)。

摘　　要：目的运用网状meta系统,分析血管生成抑制剂和聚ADP核糖聚合酶(PARP)抑制剂在治疗复发性卵巢癌中的有效性。方法采用主题词检索Pubmed、Embase、the Cochrane Library和web of science数据库,收集血管生成抑制剂和PARP抑制剂治疗复发性卵巢癌相关的随机对照试验,检索时间建库至2024年1月1日。结局指标包括无进展生存期(PFS)和总生存期(OS),使用Revman 5.4软件进行偏倚风险评估和R 4.3.1软件中gemtc包进行网状meta分析。结果在PFS指标中最终纳入34项随机对照试验,在OS指标中纳入26项。奥拉帕利(HR=0.63,95%CI:0.40~0.99),卢卡帕利(HR=0.48,95%CI:0.24~0.99),尼拉帕利(HR=0.49,95%CI:0.26~0.93),尼拉帕利+贝伐珠单抗(HR=0.17,95%CI:0.05~0.61),化疗+贝伐珠单抗+维持贝伐珠单抗(HR=0.54,95%CI:0.3~0.97)及化疗+贝伐珠单抗(HR=0.50,95%CI:0.31~0.81)相比常规铂类化疗/化疗+安慰剂均具有更长的PFS。在所有药物干预中,尼拉帕利+贝伐珠单抗的PFS最长。化疗+贝伐珠单抗(HR=0.72,95%CI:0.57~0.88)相比常规铂类化疗/化疗+安慰剂具有更长的OS。结论有限证据表明,单用血管生成抑制剂(贝伐珠单抗)或单用PARP抑制剂(尼拉帕利、奥拉帕利和卢卡帕利)均能改善复发性卵巢癌的PFS或OS,其中血管生成抑制剂和PARP抑制剂联用可能对延长复发性卵巢癌的PFS或OS更有益。Objective To evaluate the efficacy of angiogenesis inhibitors and poly ADP-ribose polymerase(PARP)inhibitors in the treatment of recurrent ovarian cancer using a mesh meta-system.MethodsSubject terms were used to search Pubmed,Embase,the Cochrane Library and web of science databases to collect randomized controlled trials related to angiogenesis inhibitors and PARP inhibitors in the treatment of recurrent ovarian cancer.The search time was established until January 1,2024.Outcome measures included progression-free survival(PFS)and overall survival(OS).Bias risk assessment was performed using Revman 5.4 software and mesh meta-analysis was performed using gemtc package in R 4.3.1 software.Results34 randomized controlled trials were included in the PFS and 26 in the OS.Olaparib(HR=0.63,95%CI:0.40-0.99),rucaparib(HR=0.48,95%CI:0.24-0.99),niraparib(HR=0.49,95%CI:0.26-0.93),niraparib+bevacizumab(HR=0.17,95%CI:0.05-0.61),chemotherapy+bevacizumab+maintenance bevacizumab(HR=0.54,95%CI:0.3-0.97)and chemotherapy+bevacizumab(HR=0.50,95%CI:0.31-0.81)had longer PFS than conventional platinum-based chemotherapy/chemotherapy+placebo.Niraparib+bevacizumab had the longest PFS of all pharmacological interventions.Chemotherapy plus bevacizumab(HR=0.72,95%CI:0.57-0.88)had a longer OS than conventional platinum-based chemotherapy/chemotherapy plus placebo.ConclusionsThere is limited evidence that angiogenesis inhibitors alone(bevacizumab)or PARP inhibitors alone(niraparib,olaparib,and rucaparib)can improve PFS or OS in recurrent ovarian cancer,and that the combination of angiogenesis inhibitors and PARP inhibitors may be more beneficial in prolonging PFS or OS in recurrent ovarian cancer.

关 键 词：血管生成抑制剂 聚ADP核糖聚合酶抑制剂 卵巢肿瘤 肿瘤复发 

分 类 号：R73[医药卫生—肿瘤]