节拍化疗治疗复发转移性乳腺癌的疗效和不良反应的meta分析

Efficacy and adverse reactions of metronomic chemotherapy in recurrent and metastatic breast cancer:a meta-analysis

目的:评价节拍化疗对复发转移性乳腺癌的疗效和不良反应。方法:检索Pubmed、Web of Science、Embase、Cochrane图书馆、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中关于节拍化疗治疗复发转移性乳腺癌的相关临床研究,检索时限均为建库起至2021年7月25日。采用RevMan 5.3软件进行统计学分析。结果:共纳入11项随机对照试验(randomized controlled trial,RCT)和3项病例对照研究,共计1082例患者。meta分析结果显示,节拍化疗组在客观缓解率(objective response rate,ORR)(比值比:1.19,95%置信区间:0.92~1.56,Z=1.31,P=0.19)和疾病控制率(disease control rate,DCR)(比值比:1.26,95%置信区间:0.93~1.71,Z=1.50,P=0.13)方面与常规化疗组无显著差异。在不良反应发生率方面,节拍化疗组的手足综合征(比值比:0.33,95%置信区间:0.22~0.50,Z=5.21,P<0.05)、消化道反应(比值比:0.36,95%置信区间:0.26~0.52,Z=5.56,P<0.05)和血液学毒性(比值比:0.27,95%置信区间:0.19~0.39,Z=6.84,P<0.05)发生率均显著低于常规化疗组。结论:节拍化疗的疗效与常规化疗相近且不良反应较少,可用于复发转移性乳腺癌的维持治疗。

Objective:To evaluate the efficacy and adverse reactions of metronomic chemotherapy for recurrent and metastatic breast cancer.Methods:The clinical researches about metronomic chemotherapy for recurrent and metastatic breast cancer were searched in Pubmed,Web of Science,Embase,Cochrane Library,China National Knowledge Infrastructure,Wanfang database,VIP database and CBM.The retrieval time was set from the establishment of the database to July 25,2021,RevMan 5.3 was adopted for statistic analysis.Results:Twelve randomized control trials(RCTs)and 3 case control studies were included,which involved 1162 patients.Meta-analysis showed that there was no significant difference in objective response rate(ORR)(odds ratio=1.19,95%confidence interval:0.92-1.56,Z=1.31,P=0.19)and disease control rate(DCR)(odds ratio=1.26,95%confidence interval:0.93-1.71,Z=1.50,P=0.13)between metronomic chemotherapy group and conventional chemotherapy group.In terms of the incidence of adverse reactions,the incidence of hand-foot syndrome(odds ratio=0.33,95%confidence interval:0.22-0.50,Z=5.21,P<0.05),gastrointestinal reaction(odds ratio=0.36,95%confidence interval:0.26-0.52,Z=5.56,P<0.05)and hematological toxicity(odds ratio=0.27,95%confidence interval:0.19-0.39,Z=6.84,P<0.05)in the metronomic chemotherapy group were lower than those in the conventional chemotherapy group.Conclusion:Compared with conventional chemotherapy,metronomic chemotherapy has similar effect and less adverse effects,which could be used for maintenance treatment of patients with recurrent and metastatic breast cancer.