抗血管生成药物阿柏西普治疗转移性结肠癌疗效与安全性的Meta分析

Meta-analysis of safety and efficacy of antiangiogenic drug aflibercept for metastatic colorectal cancer

背景目前国内外较多研究发现阿柏西普联合FOLFOX4/FOLFIRI方案治疗转移性结肠癌(metastatic colorectal cancer,mCRC)具有比较好的疗效,本研究在国内外多项研究的基础上,对于其疗效和安全性进行Meta分析,进而提供循证医学相关的依据.目的运用Meta分析系统性研究和评价阿柏西普在治疗mCRC中的治疗效果和安全性.方法检索从2009-01/2019-01阿柏西普联合FOLFOX4/FOLFIRI方案治疗mCRC的对照试验,包括:中国知网数据库、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、The Cochrane Library和EMBASE,以Cochrane系统评价手册为文献评价标准对于文献进行评价,对于所筛选的文献用Revman 5.3软件进行Meta分析,95%可信区间估计.结果本研究共纳入5篇文献,Meta分析结果表明:实验组患者在3年总生存率和3年无进展生存率方面的生存率高于对照组,差异有统计学意义(OR=0.52,95%CI:0.35-0.79,P=0.002;OR=0.63,95%CI:0.45-0.89,P=0.008).实验组患者在总不良反应方面的发生率低于对照组患者,二者差异有统计学意义(OR=0.58,95%CI:0.40-0.84,P=0.004),在腹泻、白细胞减少、食欲减退、恶心呕吐发生率均低于对照组,二者差异有统计学意义(P<0.05).结论阿柏西普联合FOLFOX4/FOLFIRI方案治疗mCRC较FOLFOX4/FOLFIRI治疗mCRC的效果好且安全性较高.

BACKGROUND Numerous studies have reported that the combination of arbacicept and FOLFOX4/FOLFIRI regimen can more effectively treat metastatic colon cancer(mCRC).In the preset study,we performed a meta-analysis to assess the efficacy and safety of arbacicept for mCRC to provide an evidence-based medicine related basis for the application of this drug.AIM To systematically assess the clinical efficacy and safety of aflibercept for patients with metastatic colorectal cancer(mCRC)by meta-analysis.METHODS Controlled trials that involved aflibercept with FOLFOX4/FOLFIRI regimen for treating mCRC from January 2009 to January 2019 were searched,covering China HowNet database,Weipu database,Wanfang database,China Biomedical Literature database,PubMed,as well as The Cochrane Library and EMBASE.The retrieved studies were evaluated according to the Cochrane Systematic Evaluation Manual.A metaanalysis was performed with RevMan5.3 software and 95%confidence interval(CI)estimation.RESULTS Five studies were included.The results of the metaanalysis showed that the 3-year overall survival rate and 3-year recurrence-free survival rate were significantly higher in the study group than in the control group(OR[odds ratio]=0.52,95%CI:0.35-0.79,P=0.002;OR=0.63,95%CI:0.45-0.89,P=0.008).Compared with the control group,the study group had fewer adverse events(OR=0.58,95%CI:0.40-0.84,P=0.004).Furthermore,the study group had a significantly lower incidence of diarrhea,leukopenia,loss of appetite,and nausea and vomiting than the control group(P<0.05).CONCLUSION Aflibercept with FOLFOX4/FOLFIRI regimen has better efficacy and adverse event profile for treatment of refractory mCRC than FOLFOX4/FOLFIRI alone.