利妥昔单抗联合CHOP方案治疗中国人群弥漫大B细胞淋巴瘤效果及安全性的Meta分析

Meta-analysis of efficacy and safety of Rituximab combined with CHOP regimen in the treatment of diffuse large B-cell lymphoma in Chinese population

目的系统评价利妥昔单抗联合CHOP方案治疗中国人群弥漫大B细胞淋巴瘤的效果及安全性。方法计算机检索2005年1月~2017年6月中国期刊全文数据库、中文科技期刊全文数据库、Pub Med、EMBase、Medline、Cochrane图书馆。收集利妥昔单抗联合CHOP方案(治疗组)对比单用CHOP(对照组)治疗弥漫大B细胞淋巴瘤的随机对照试验(RCT),对符合纳入标准的临床研究进行质量评价和资料提取后,采用Rev Man 5.3软件进行Meta分析。结果共纳入27项RCT,合计患者2134例。Meta结果显示治疗组完全缓解率(OR=2.13,95%CI:1.77~2.57,P<0.01)、总有效率(OR=3.06,95%CI:2.40~3.91,P<0.01)、总生存率(OR=2.40,95%CI:1.89~3.04,P<0.01)均高于对照组,差异有统计学意义。在亚组分析方面,不同疗程的患者在完全缓解率(OR=2.30,95%CI:1.80~2.95,P<0.01)、总有效率(OR=3.41,95%CI:2.51~4.63,P<0.01)方面差异有统计学意义,不同CHOP药物的患者在完全缓解率(OR=2.24,95%CI:1.84~2.72,P<0.01)、总有效率(OR=3.06,95%CI:2.40~3.91,P<0.01)方面差异均有统计学意义。结论利妥昔单抗联合CHOP方案治疗弥漫大B细胞淋巴瘤的效果及安全性较好。但由于纳入研究的质量等限制,结论有待进一步加以验证。

Objective To systematically review the efficacy and safety of Rituximab combined with CHOP for treating diffuse large B-cell lymphoma （DLBCL） of Chinese population. Methods From January 2005 to June 2017, the Chinese Journal Full-text Database, VIP, PubMed, EMBase, Medline and Cochrance Library were retrieved to collect the randomized controlled trials （RCT） of Rituximab combined CHOP （treatment group） comparing with single CHOP （control group） for treating DLBCL. After the quality evaluation and information collection of clinical studies with inclusion criteria, RevMan 5.3 software was conducted for Meta-analysis. Results There were totally 27 RCTs involving 2134 patients. Meta-analysis results showed that the complete remission rate （OR = 2.13, 95%CI： 1.77-2.57, P 〈 0.01）; response rate （OR = 3.06, 95%CI： 2.40-3.91, P 〈 0.01）; survival rate （OR = 2.40, 95%CI： 1.89-3.04, P 〈 0.01） in the treatment group were significantly higher than those of control group, with significant differences. In the subgroup analysis, the com- plete remission rate （OR = 2.30, 95%CI： 1.80-2.95, P 〈 0.01）, total efficiency （OR = 3.41, 95%CI： 2.51-4.63, P 〈 0.01） in different courses had statistically significant differences; the complete remission rate （OR = 2.24, 95%CI： 1.84-2.72, P 〈 0.01）, total efficiency （OR = 3.06, 95%CI： 2.40-3.91, P 〈 0.01） in different CHOP drugs had statistically significant differences. Conclusion Rituximab combined with CHOP in the treatment of DLBCL has good curative effect and safety. Due to the limitation of research quality, the conclusion remains to be further verified.