锝[^(99)Tc]亚甲基二膦酸盐注射液单药及联合^(89)SrCl_(2)治疗骨转移瘤效果的meta分析

A meta-analysis of the efficacy of ^(99)Tc-MDP alone and in combination with ^(89)SrCl_(2) in the treatment of bone metastases

背景与目的:骨转移瘤是常见的肿瘤骨转移疾病,且患者预后较差,常会合并多种严重并发症,包括骨痛、骨折、脊髓压迫等骨相关事件(skeletal-related event,SRE),影响患者的生活质量。放射性核素治疗对骨转移患者具有较好的效果,可以明显地缓解骨痛。本研究旨在评价锝[^(99)Tc]亚甲基二膦酸盐注射液(^(99)Tc-MDP)单用或联合氯化锶(^(89)SrCl_(2))治疗骨转移瘤的疗效。方法:数据库检索公开发表在2000年1月—2022年7月的关于^(99)Tc-MDP联合^(89)SrCl_(2)及单用^(99)Tc-MDP治疗骨转移瘤疗效的研究报道,对所有纳入的文献进行资料提取和质量评价,采用Revman 5.3软件进行meta分析。结果:27篇文献符合纳入标准,共2564例患者纳入本研究。结果显示,与^(89)SrCl_(2)单药组比较,^(99)Tc-MDP联合^(89)SrCl_(2)可提高骨转移瘤患者的骨痛缓解率(RR=1.22,95%CI:1.18~1.27,P<0.001),骨转移灶愈合率(RR=1.35,95%CI:1.25~1.47,P<0.001);单用^(99)Tc-MDP与^(89)SrCl_(2)单药组相比,骨痛缓解率(RR=0.98,95%CI:0.90~1.06,P=0.57)及骨转移灶愈合率(RR=0.93,95%CI:0.82~1.06,P=0.27),差异无统计学意义。^(99)Tc-MDP单用或联合^(89)SrCl_(2)治疗的常见不良反应为白细胞、血小板计数降低,但单用或者联合使用不良反应发生率差异无统计学意义(单用^(89)SrCl_(2)vs^(99)Tc-MDP联合^(89)SrCl_(2):RR=0.83,95%CI:0.53~1.30,P=0.42;单用^(89)SrCl_(2)vs单用^(99)Tc-MDP:RR=0.93,95%CI:0.76~1.13,P=0.45)。结论:^(99)Tc-MDP联合^(89)SrCl_(2)治疗能够有效地缓解骨转移瘤患者的疼痛,其骨转移瘤的骨痛缓解率及骨转移灶愈合率均优于^(89)SrCl_(2)单药治疗组,且不良反应未明显增加。由于本研究在纳入文献质量及数量等方面存在局限性,故今后需要更高质量的随机对照研究验证。

Background and purpose:Bone metastatic tumor is a common disease of tumor bone metastasis,and the prognosis of patients is poor,with a variety of serious complications,including bone pain,fracture,spinal cord compression and other skeletal related events,affecting the quality of life of patients.At present,radionuclide therapy still has positive clinical effects in patients with bone metastasis,and it still plays an important role in relieving bone pain.This study aimed to evaluate the efficacy of technetium[^(99)Tc]methylene diphosphonate injection(^(99)Tc-MDP)alone or in combination with strontium chloride(^(89)SrCl_(2))in the treatment of bone metastases.Methods:Databases were used to search for studies published between January 2000 and July 2022 on the efficacy of ^(99)Tc-MDP in combination with ^(89)SrCl_(2) and ^(99)Tc-MDP alone in the treatment of bone metastases.All included literature was extracted and evaluated for quality,and Meta-analysis was performed using RevMan 5.3 software.Results:Twenty-seven publications met the inclusion criteria,and a total of 2564 patients were included in this study.The results demonstrated that ^(99)Tc-MDP combined with ^(89)SrCl_(2) improved bone pain relief(RR=1.22,95%CI:1.18-1.27,P<0.001)and bone metastasis healing(RR=1.35,95%CI:1.25-1.47,P<0.001).However,when compared with ^(89)SrCl_(2) alone,it could not be concluded that ^(99)Tc-MDP alone increased the rate of bone pain relief(RR=0.98,95%CI:0.90-1.06,P=0.57)and bone metastasis healing(RR=0.93,95%CI:0.82-1.06,P=0.27),and the difference between the two groups was not statistically significant.The common adverse effects of ^(99)Tc-MDP treatment alone or in combination with ^(89)SrCl_(2) were decreased leukocyte and platelet counts,however,the difference in the incidence of adverse effects between ^(99)Tc-MDP treatment alone and in combination with ^(89)SrCl_(2) was not statistically significant(^(89)SrCl_(2) vs ^(99)Tc-MDP in combination with ^(89)SrCl_(2):RR=0.83,95%CI:0.53-1.30,P=0.42;^(89)SrCl_(2) vs ^(99)Tc-MDP:RR=0.93,95%CI:0.76-1.13,P=0.45).Conclusion:^(99)Tc-MDP combined with ^(89)SrCl_(2) treatment was effective in relieving pain in patients with bone metastases,and the bone pain relief rate and bone metastasis healing rate of ^(99)Tc-MDP combined with ^(89)SrCl_(2) treatment for bone metastases were better compared with the ^(89)SrCl_(2) monotherapy group,with no significant increase in adverse reactions after typical dosing.Due to the limitations of the quality and quantity of literature included in this study,higher quality randomized controlled studies are needed.