替莫唑胺对比传统化疗药治疗脑胶质瘤疗效的系统评价

Efficacy of temozolomide versus traditional chemotherapy drugs in treatment of gliomas: a systematic review

目的系统评价替莫唑胺对比传统化疗药治疗脑胶质瘤的疗效。方法计算机检索国内外文献数据库(时限均从建库开始至2013年7月),收集术后放疗基础上替莫唑胺与传统化疗药治疗脑胶质瘤的随机对照试验,2名研究者独立提取资料和质量评价,使用RevMan 5.2软件进行Meta分析。结果最终纳入8个RCTs,864例患者,其中替莫唑胺组374例,传统化疗药物组490例。Meta分析结果显示,替莫唑胺与传统化疗药比较,两者在治疗有效率[RR=1.48,95%CI(1.24,1.77)]、5年生存率[HR=23.94,95%CI(13.26,43.22)]、无进展生存期[MD=4.00,95%CI(2.61,5.39)]、平均生存期[SMD=1.84,95%CI(1.40,2.27)]、消化道反应[RR=0.53,95%CI(0.39,0.71)]和骨髓抑制[RR=0.20,95%CI(0.08,0.51)]等方面差异均有统计学意义,替莫唑胺优于传统化疗药。结论替莫唑胺在提高脑胶质瘤患者的疗效,延长生存期,减少不良反应等方面均优于传统化疗药。

Objective To compare the efficacy of temozolomide （TMZ） and traditional chemotherapy drugs for glioma patients during postoperative radiotherapy. Methods PubMed, EMBASE, the Cochrane Library, CNKI, Wanfang Data, VIP, and CBM were searched to identify randomized controlled trials （RCTs） comparing TMZ with traditional chemotherapy drugs （in addition to postopera- tive radiotherapy） for glioma patients published up to July 2013. Two researchers independently screened the studies according to pre- defined inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. In the case of di- vergence during the extraction of data, consensus was reached by discussion or introduction of a third reviewer. A recta-analysis was performed using RevMan 5.2 software. Results A total of 8 RCTs involving 864 patients were finally selected, with 374 cases in TMZ group and 490 cases in traditional chemotherapy drug group. Compared with the traditional chemotherapy drug group, the TMZ group had significantly increased response rate （ RR = 1.48,95% CI 1.24,1.77 ） , 5-year survival rate （ HR = 23.94,95% CI 13.26, 43.22）, progression-free survival （MD =4.00,95% CI 2.61,5.39）, and mean survival （SMD = 1.84,95% CI 1.40,2.27） （P 〈0.05 for all） and significantly reduced incidence of alimentary tract reactions （RR =0.53,95% CI 0.39,0.71 ） and bone mar- row suppression （ RR = 0.20,95% CI 0. 08,0.51 ） （ P 〈 0. 05 for all）. Conclusions Compared with traditional chemotherapy drugs, TMZ has improved efficacy and reduced adverse effects and can prolong survival for glioma patients during postoperative radiotherapy.