FMS样酪氨酸激酶3突变对急性早幼粒细胞白血病预后影响的Meta分析

Effect of FMS-like tyrosine kinase 3 mutations on prognosis of acute promyelocytic leukemia:a Meta-analysis

目的系统评价FMS样酪氨酸激酶3(FLT3)突变对急性早幼粒细胞白血病预后的影响.方法检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMBase、CochraneLibrary数据库,根据纳入和排除标准筛选从建库至2017年12月公开发表的队列研究和病例对照研究,进行质量评价和数据提取,并采用RevMan5.3软件进行统计学分析.结果最终纳入23篇文献,共2632例患者.Meta分析结果显示,FLT3内部串联重复(FLT3﹣ITD)突变患者的完全缓解率较低(RR=0.92,95%CI0.86~0.99,P=0.02),3年总生存率较低(RR=0.72,95%CI0.60~0.88,P=0.001),5年总生存率较低(RR=0.89,95%CI0.81~0.99,P=0.03),而高危组比例较高(RR=3.13,95%CI2.26~4.35,P<0.01),早期死亡率较高(RR=2.26,95%CI1.75~2.90,P<0.01),复发率较高(RR=1.50,95%CI1.11~2.02,P=0.008),差异均具有统计学意义.FLT3酪氨酸激酶结构域(FLT3﹣TKD)突变患者早期死亡率较高(RR=3.00,95%CI1.74~5.20,P<0.01),差异具有统计学意义.结论FLT3突变可影响急性早幼粒细胞白血病患者的预后,可更好地为进行预后分层、完善治疗方案、改善患者预后提供研究方向.

Objective To systematically evaluate the effect of FMS-like tyrosine kinase 3(FLT3)mutations on prognosis of acute promyelocytic leukemia.Methods The databases of CNKI,Wanfang,VIP,China Biology Medicine disc,PubMed,EMBase,and Cochrane Library were retrieved,and the cohort studies and case-control studies published from the establishment of the databases to December 2017 were selected according to the inclusion and exclusion criteria.The quality assessment and data extraction was performed and the statistical analysis was performed by using RevMan 5.3 software.Results Twenty-three studies were included,covering a total of 2 632 patients.Meta-analysis showed that patients with FLT3 internal tandem duplication(FLT3-ITD)mutation had lower complete remission rate(RR=0.92,95%CI 0.86-0.99,P=0.02),3-year overall survival rate(RR=0.72,95%CI 0.60-0.88,P=0.001)and 5-year overall survival rate(RR=0.89,95%CI 0.81-0.99,P=0.03),while the proportion of high-risk group(RR=3.13,95%CI 2.26-4.35,P<0.01),the early mortality rate(RR=2.26,95%CI 1.75-2.90,P<0.01)and the recurrence rate(RR=1.50,95%CI 1.11-2.02,P=0.008)were relatively high,and the differences were statistically significant.The patients with FLT3 tyrosine kinase domain(FLT3-TKD)mutation had higher early mortality rate(RR=3.00,95%CI 1.74-5.20,P<0.01),and the difference was statistically significant.Conclusion The FLT3 mutations can influence the prognosis of acute promyelocytic leukemia,which contributes to the research direction of better prognosis stratification,perfect treatment regimen and improved prognosis.