R—CHOP方案对低中度恶性B细胞非霍奇金淋巴瘤疗效及不良反应的Meta分析

Meta-analysis on the efficacy and safety of R-CHOP chemotherapy for the treatment of low and moderate malignant B cell non-Hodgkin lymphoma

目的综合评价利妥昔单抗联合CHOP（R—CHOP）方案化疗与单纯CHOP方案化疗对低中度恶性B细胞非霍奇金淋巴瘤（NHL）的疗效及患者不良反应。方法应用国际Cochrance协作网的系统评价方法，搜集世界范围内关于低中度恶性B细胞NHL患者接受R—CHOP方案化疗与单纯CHOP方案化疗疗效比较的随机试验研究，并对研究结果进行系统评价。结果共检索到7个试验包括1569例患者，异质性检验提示不存在异质性（x=5．31，P=0．50），其基线情况具有可比性，采用固定效应模型进行综合分析，结果显示R—CHOP方案化疗组的完全缓解率高于单纯CHOP化疗组（OR=2．22，95％C11．72～2．85，P〈0．00001）；其不良反应与对照组比较差异无统计学意义（P均〉O．05）。结论R-CHOP方案化疗对低中度恶性B细胞NHL有良好的疗效，不良反应与单纯CHOP方案化疗无显著区别，应推荐作为低中度恶性B细胞NHL治疗的首选方案，有必要开展更多设计良好的临床随机对照试验，进一步证明其临床效果。

Objective To comprehensively evaluate the curative effect and adverse effects of rituximab plus cyclophosphamide, vincristine, doxorubiein and prednisone（R-CHOP） chemotherapy and CHOP chemotherapy alone on the treatment for low and moderate malignant B cell non-Hodgkin lymphoma （NHL）. Methods By the application of the systematic review method of Coehrance International Collaboration, the world-wide randomized controlled trials （RCT） on the comparison between different curative effects of R- CHOP and CHOP chemotherapy alone on the treatment low and moderate malignant B cell NHL was collected and the study results was evaluated systematically. Results Seven RCT studies involving 1569 patients and had no heterogeneity between themselves （X2=5.31,P=0.50）. The baseline of patients＇ characteristics was comparable in all the studies. By comparing complete response （CR） rate and adverse effects through fixed effect analysis model, the results showed that R-CHOP was better than CHOP chemotherapy on the treatment for low and moderate malignant B cell NHL（OR =2.22, 95 %CI 1.72-2.85, P 〈0.000 01）, and adverse events of R-CHOP had no significant difference compared with CHOP chemotherapy alone （P 〉0.05）. Conclusion With good curative effect on the treatment low and moderate malignant B cell NHL and without obvious differences from the CHOP chemotherapy alone in adverse effects, R-CHOP chemotherapy should be recommended as the best treatment method for low and moderate malignant B cell NHL. And much more well-designed clinical RCT should be made to further prove its clinical effect.