靶向药物治疗晚期肾癌的meta分析

A Meta-analysis of molecular targeted therapeutic drugs for advanced renal cancer

目的:系统评价靶向药物治疗晚期肾癌的有效性和安全性。方法:计算机检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdice)等,同时追查纳入的参考文献,收集靶向药物治疗晚期肾癌的随机对照试验。根据Cochrane Handbook 5.0的质量评价标准评价,采用RevMan 5.0软件进行统计学分析。结果:最终纳入5个随机对照试验,共2946例患者。meta分析结果显示,与干扰素相比,靶向药物单药虽未能提高晚期肾癌的有效率,却显著提高了晚期肾癌的疾病控制率(OR=2.89,95%CI:2.22-3.77,P<0.001)。靶向药物联合干扰素不但显著提高了晚期肾癌的疾病控制率(OR=2.14,95%CI:1.70-2.69,P<0.00001),还显著提高了有效率(OR=2.52,95%CI:1.90-3.33,P<0.00001)。与干扰素相比,靶向药物的不良反应明显增加,尤以3/4级心血管不良事件(OR=6.29,95%CI:1.77-22.27,P=0.004)、3/4级皮肤不良事件(OR=8.28,95%CI:3.91-17.56,P<0.0001)以及重度疼痛(OR=2.41,95%CI:1.38-4.24,P=0.002)的发生率增加最为明显。靶向药物与干扰素联用组的3/4级胃肠道反应(OR=2.08,95%CI:1.56-2.78,P<0.00001)、心血管(OR=8.67,95%CI:1.86-40.41,P=0.006)不良事件以及疲劳、无力等全身症状(OR=1.48,95%CI:1.20-1.83,P=0.0002)的发生率显著高于干扰素组。结论:与干扰素相比,靶向药物单用能更有效地控制晚期肾癌的进展,靶向药物联合干扰素可进一步提高疗效,是晚期肾癌较好的解救方案,但也伴随更多不良反应的发生。

Objective：To evaluate the efficacy and safety of the molecular targeted therapeutic drugs（MTTD） for advanced renal cell carcinoma treatment.Methods：We searched the randomized controlled trials of MTTD and interferon for advanced renal cancer treatment.The database of Pubmed,MEDLINE,the Cochrane Central Register of Controlled Trials（RCTs）,China National Knowledge Infrastructure（CNKI）,China Biology Medicine disc（CBMdisc） were included.Methodological quality of the selected trials was evaluated according to the Cochrane handbook 5.0,and Meta analysis was utilized with RevMan 5.0 software.Results：Five RCTs,totally of 2946 patients,were identified and included in present study.Meta anlysis showed that combined application of MTTD and interferon,but not MTTD alone,could significantly improve the overall effective rate of treatment against advanced renal cancer,as compared with that of interferon（OR=2.52,95%CI：1.90-3.33,P0.00001）.MTTD,either with or without interferon,could siginicantly increase the disease control rate with OR values of 2.89（95%CI：2.22-3.77,P0.001） and 2.14（95%CI：1.70-2.69,P0.00001）,respectively in comparison with interferon alone.However,more severe side effects,including skin（OR=8.28,95%CI：3.91-17.56,P0.000）,pain（OR=2.41,95%CI：1.38-4.24,P=0.002）,and cardiovascular adverse events（OR=6.29,95%CI：1.77-22.27,P=0.004） were observed using MTTD in comparison with interferon.Combination of MTTD and interferon could also significantly increased the rate of general and severe gastrointestinal and cardiovascular adverse events.Conclusion：MTTD monotherapy controls the progression of renal cancer better than interferon,and a combined application of MTTD and interferon inproves overall effective rate siginicantly,and therefore could be used as a better rescue plan for the renal cancer treatment,although with a potential of more adverse events.