重组人血管内皮抑制素联用铂类制剂治疗恶性胸腔积液系统评价再评价

Recombinant human endostatin combined with platinum compounds for malignant pleural effusion:an overview of systematic reviews

目的对重组人血管内皮抑制素联合铂类制剂治疗恶性胸腔积液(malignant pleural effusion,MPE)的系统评价进行再评价。方法制定纳入排除标准,检索Embase、PubMed、Clinical Trials、Cochrane Library、中国知网、维普和万方数据库,检索时限设为1999年1月-2021年12月,筛选重组人血管内皮抑制素联用铂类制剂治疗MPE的系统评价。用PRISMA声明评估报告质量,用AMSTAR 2量表评价方法学质量,用GRADE工具对其进行证据等级评估,最后采用RevMan 5.3软件定量合并分析证据水平较低的结局指标的原始研究效应值。结果最终纳入9篇系统评价/meta分析,包含8个主要结局指标,累计50个评价结果。纳入的系统评价PRISMA平均得分为(22.28±1.37)分,6篇报告相对完全,3篇存在一定报告缺陷;9篇系统评价的方法学质量均为极低;50个评价结果的证据质量等级大多为低质量(31个)和中等质量(18个)。9篇系统评价的研究结果均表明,二联疗法相比单用铂类制剂治疗MPE临床疗效更为满意,再次定量分析显示二者不良事件发生率比较差异无统计学意义(P>0.05)。结论综合考虑现有证据及meta分析结果表明,重组人血管内皮抑制素和铂类制剂组成的二联疗法治疗MPE效果更佳,相关不良事件发生率无差异。但因其方法学质量和结局指标证据质量等级不高,以上结论仅能提供一定的参考,需要进一步的研究证实。

Objective To overview the systematic reviews of recombinant human endostatin combined with platinum compounds for malignant pleural effusion(MPE).Methods According to the inclusion and exclusion criteria and searching strategies,we screened the systematic reviews of recombinant human endostatin combined with platinum compounds for the treatment of MPE by searching the Embase,PubMed,Clinical Trials,Cochrane Library,China National Knowledge Infrastructure,CQVIP Database and Wanfang Database.The searching time was from January 1999 to December 2021.The methodological quality was evaluated using AMSTAR 2 tool,the report quality was evaluated using PRISMA statement,and the evidence quality of the outcome indicators was graded according to the GRADE system.Finally,RevMan 5.3 software was used to quantitatively merge and analyze the original research effect values of the main outcome indicators with low level of evidence.Results A total of 9 systematic reviews/meta-analyses involving8 outcome indicators and totally 50 outcomes were included.The average PRISMA scale score was 22.28±1.37,with6 reports being relatively complete and 3 reports having certain reporting defects.The overall methodological quality of the 9 systematic reviews was extremely low.Most of the 50 outcomes were graded as“low”(31 outcomes)or“intermediate”(18 outcomes)quality.The results of 9 systematic reviews all showed that the clinical efficacy of dual therapy was more satisfactory than that of platinum-based preparations in the treatment of MPE,and re-quantitative analysis also confirmed that there was no statistically significant difference in the incidence of adverse events between the two treatments(P>0.05).Conclusions Considering the existing evidence and the results of meta-analysis,the dual therapy composed of recombinant human endostatin and platinum compounds is more effective in the treatment of MPE,and there is no difference in the incidence of related adverse events.However,because of its poor methodological quality and the low level of evidence,the above conclusions can only provide a certain reference and need to be confirmed by further research.