贝伐珠单抗联合化疗治疗晚期大肠癌的疗效和安全性的meta分析

Efficacy and safety of bevacizumab combined with chemotherapy in the treatment of advanced colorectal cancer: a meta analysis

目的系统评价贝伐珠单抗联合化疗治疗晚期大肠癌的有效性和安全性。方法对Pubmed、Cochrane Library、中国知网(CNKI)、维普和万方数据库进行检索,筛选有关贝伐珠单抗联合化疗治疗晚期大肠癌的随机对照试验,检索年限均为从建库至2017年4月。使用修改后的Jadad量表对文献进行评价后提取数据,并用Cochrane协作网提供的Rev Man5. 3软件进行Meta分析,计算比值比(OR)及95%可信区间(CI)。结果最终纳入14个随机对照试验(RCT)。Meta分析结果显示,与单纯化疗组相比,贝伐珠单抗联合化疗组的CR(OR=2. 68,95%CI:1. 62～4. 44,P=0. 001)、PR(OR=2. 42,95%CI:1. 87～3. 13,P <0. 001)、RR(OR=2. 73,95%CI:2. 08～3. 59,P <0. 001)以及中位无进展生存期(m PFS)、中位总生存期(m OS)方面均显示出优势。常见不良反应中胃肠道不良反应发生率(OR=0. 95,95%CI:0. 64～1. 39,P=0. 78)、白细胞减少(OR=1. 23,95%CI:0. 54～2. 81,P=0. 62)的差异均无统计学意义,贝伐珠单抗联合化疗组中性粒细胞减少不良反应的发生率(OR=0. 79,95%CI:0. 67～0. 92,P=0. 004)及肝损伤的不良反应发生率(OR=0. 39,95%CI:0. 19～0. 78,P=0. 008)的差异无统计学意义(P> 0. 05)。胃肠道不良反应在剔除异质性来源时表现为差异具有统计学差异(P=0. 004)。结论贝伐珠单抗联合化疗治疗晚期大肠癌的疗效优于单纯化疗,而常见的不良反应要警惕胃肠道不良反应及肝损伤。

Objective To evaluate systemically the efficacy and safety of bevacizumab combined with chemotherapy in the treatment of advanced colorectal cancer.Methods Data from the Pubmed,Cochrane Library,China Knowledge Resource Integrated Database (CNKI),China Science and Technology Journal Database (VIP)and Wanfang China Knowledge Resource Integrated Database (CNKI)were retrieved to screen the randomized controlled trials of bevacizumab combined with chemotherapy in the treatment of late colorectal cancer.Length of retrieval was from the inception to April 2017.Data were collected after literature evaluation by using the modified Jadad scale,and the RevMan5.3 softwareprovided by the Cochrane Collaboration Network was used for Meta analysis,and the ratio (OR)and the 95% confidence interval (CI)were calculated.Results Finally,14 randomized controlled trials (RCT)were included.Meta analysis showed that the CR (OR =2.68,95% CI:1.62-4.44,P =0.0001),PR (OR =2.42,95%CI:1.87- 3.13,P <0.001),RR (OR =2.73,95% CI:2.08-3.59,P <0.001),(mPFS)and median total survival (mOS)of the bevacizumab combined with chemotherapy group were superior to those of the simple chemotherapy group.There was no statistical significance in the incidence of gastrointestinal adverse reactions (OR =0.95,95% CI:0.64-1.39,P =0.78),as well as in leukopenia (OR = 1.23,95%CI:0.54-2.81,P =0.62)in ordinary adverse reactions.Statistical significance could neither be seen in the incidence of neutropenia (OR=0.79,95% CI:0.67-0.92,P=0.004)and hepatic injury (0R=0.39,95%CI:0.19-0.78,P=0.008)in the bevacizumab combined with chemotherapy group,as compared with those of the simple chemotherapy group.Adverse reactions involving gastrointestinal tract were statistically different,after deleting the source of heterogeneity (P =0.004).Conclusion The effica-cy of bevacizumab combined with chemotherapy in the treatment of advanced colorectal cancer was superior to that of simple chemotherapy.During treatment,close attention should be paid to common adverse reactions involving gastrointestinal tract and liver.