贝伐单抗局部应用治疗恶性胸腹水的 meta 分析

Efficacy of Bevacizumab for patients with malignant pleural effusion or ascites

目的：贝伐单抗是抑制血管内皮生长因子受体（vascular endothelial growth factor receptor,VEGF）的重组人源化抗体,本研究旨在系统评价腹腔局部应用贝伐单抗联合化疗治疗恶性胸腹水的疗效及安全性。方法计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普数据库（VIP）、万方数据库、The Cochrane Library、PubMed、EMBASE 及 SCI 等数据库,收集有关贝伐单抗联合化疗治疗恶性胸腹水的随机对照试验（randomized control trial,RCT）；主要结局指标包括有效率、完全缓解（complete remission,CR）、部分缓解（partial remission,PR）、毒性反应；采用比值比（odds ratio,OR ）,95%可信区间（95% CI ）表示,Review Manager5.0统计软件进行 meta 分析。结果共纳入6项 RCT,共330例伴有恶性胸腹水患者,meta 分析结果显示,与单纯化疗方案比较,腹腔局部注射贝伐单抗联合化疗方案较化疗单药可提高恶性胸腹水治疗有效率（OR =0.23,95% CI ：0.13~0.39,P 〈0.05）,描述性分析发现贝伐单抗局部应用并未增加其它毒性反应的发生率。结论化疗基础上贝伐单抗局部注射可以明显缓解或控制恶性胸腹水,且该治疗方案没有增加不良反应,安全性可靠。

Objective Bevacizumab,a humanized monoclonal antibody raised against vascular endothelial growth factor,has been used widely in clinic.We performed this meta-analysis to observe the efficacy of local application of bevacizumab for patients with malignant pleural effusionor ascites.Methods We searched Pubmed,CBM,CNKI,VIP,Cochrane library,EMbase,and identified 6 randomized controlled clinical trials published within 2000 to now for meta-analysis.Results Six eligible studies that included 330 patients were found,in these studies,bevacizumab was administered to 1 70 patients.The outcomes of treatment efficacy included odds ratio （OR）,complete remission （CR）,partial remission （PR）.Comparing bevacizumabcombined chemotherapy with chemotherapy alone for the efficacy of MPE or ascites.The pooled OR of response rate was 4.44（95% CI ：2.57,7.69）,the pooled OR for CR was 2.67（95% CI ：1.49,4.80）,the pooled OR for PR was 1.31（95% CI ：0.83,2.07）,respectively.In addition,no significant difference of severe adverse events （SAEs） in bevacizumab groups as compared with control groups.Conclusions Local application of bevacizumabmay significantly relieve malignant pleural effusion or ascites.Larger well designed randomized control trails should be carried out in the future to clarify the role of bevacizumab in the treatment of patients with malignant pleural effusion or ascites.