XELOX方案与FOLFOX方案治疗转移性结直肠癌的系统评价

Systematic Review of XELOX Regimen and FOLFOX Regimen for Metastatic Colorectal Cancer

目的:评价XELOX方案与FOLFOX方案治疗转移性结直肠癌的有效性和安全性。方法:采用计算机检索Cochrane Library、PubMed、Embase、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据库,对符合纳入标准的随机对照试验(RCT)进行质量评价和Meta分析。结果:共纳入9个RCT,包括2120例患者。2种方案在总体应答率、完全应答率、部分应答率、总体生存率、无病进展存活率、中位生存期、中位疾病进展时间上差异均无统计学意义;Ⅰ/Ⅱ级不良反应中XELOX方案的手足综合征(RR=1.99,95%CI(1.07,3.70),P=0.03)、白细胞减少(RR=1.42,95%CI(1.09,1.85),P=0.009)的发生率高于FOLFOX方案,Ⅲ/Ⅳ级不良反应中XELOX方案的腹泻(RR=1.67,95%CI(1.34,2.08),P<0.0001)、手足综合征(RR=4.19,95%C(I2.51,6.98),P<0.0001)、血小板减少(RR=1.80,95%CI(1.26,2.56),P=0.001)的发生率高于FOLFOX方案。结论:XELOX方案治疗转移性结直肠癌的疗效与FOLFOX方案相似,但需密切关注XELOX方案更易发生手足综合征、血小板减少、腹泻的风险。

OBJECTIVE：To evaluate the effectiveness and safety of XELOX regimen and FOLFOX regimen for metastatic colorectal cancer.METHODS：The seven databases as follows：Cochrane Library,PubMed,Embase,CBM,CNKI,VIP,WanFang,were retrieved by computer.Randomized controlled trials（RCT） in the treatment of metastatic colorectal cancer were included for quality assessment and Meta-analysis.RESULTS：A total of 9 RCTs involving 2 120 participants were included.There was no significant difference in overall response,complete response,partial response,overall survival,progression-free survival,median overall survival and median time to progression between the two regimens.In ADR,grade Ⅰ/Ⅱ hand-foot syndrome（RR=1.99,95%CI（1.07,3.70）,P=0.03）,grade Ⅰ/Ⅱ leukopenia（RR=1.42,95%CI（1.09,1.85）,P=0.009）,grade Ⅲ/Ⅳ diarrhea（RR=1.67,95%CI（1.34,2.08）,P0.000 1）,grade Ⅲ/Ⅳ hand-foot syndrome（RR=4.19,95%CI（2.51,6.98）,P0.000 1）and grade Ⅲ/Ⅳ thrombocytopenia（RR=1.80,95%CI（1.26,2.56）,P=0.001）were all higher in the XELOX regimen than in the FOLFOX regimen.CONCLUSION：XELOX regimen has similar effectiveness with FOLFOX regimen,but the higher risk of hand-foot syndrome,thrombocytopenia and diarrhea needs closely concern.