贝伐珠单抗联合顺铂治疗非小细胞肺癌合并恶性胸腔积液疗效及安全性的Meta分析

Meta analysis of efficacy and safety of bevacizumab combined with cisplatin in the treatment of non-small cell lung cancer with malignant pleural effusion

目的系统评价贝伐珠单抗联合顺铂胸腔灌注治疗非小细胞肺癌(NSCLC)合并恶性胸腔积液(MPE)的疗效及安全性。方法检索PubMed、Embase、The Cochrane Library、Web of Science、ProQuest、中国生物医学文献数据库、中国知网、维普、万方数据库中收录的关于贝伐珠单抗联合顺铂对比顺铂胸腔灌注治疗NSCLC合并MPE的随机对照试验,检索时间均从建库至2022年4月18日。依照Cochrane系统评价方法对纳入的随机对照试验进行质量评价,采用RevMan5.3和Stata15软件进行Meta分析。结果本研究最终纳入14项随机对照试验,共计932例患者。Meta分析结果显示,试验组患者总有效率(RR=1.42,95%CI:1.30~1.54,P﹤0.01)和生活质量改善率(RR=1.57,95%CI:1.27~1.94,P﹤0.01)均明显高于对照组,胸腔积液中血管内皮生长因子(VEGF)水平明显低于对照组(MD=-56.50,95%CI:-67.79~-45.21,P﹤0.01)。试验组和对照组患者胃肠道反应、骨髓抑制、肝肾功能异常、高血压、出血事件发生率比较,差异均无统计学意义(P﹥0.05)。结论贝伐珠单抗联合顺铂胸腔灌注治疗NSCLC合并MPE可提高疗效,抑制MPE生成,同时不增加不良反应发生率。

Objective To systematically evaluate the efficacy and safety of bevacizumab combined with cisplatin in the treatment of non-small cell lung cancer(NSCLC)with malignant pleural effusion(MPE).Method Randomized controlled trials of bevacizumab combined with cisplatin versus cisplatin pleural perfusion in the treatment of NSCLC combined with MPE were searched in PubMed,Embase,The Cochrane Library,Web of Search,ProQuest,China Biomedical Literature Database,CNKI,VIP and Wanfang databases,the retrieval time was from the establishment of the database to April 18,2022.The quality of the included randomized controlled trials was evaluated according to Cochrane systematic review method,and Meta analysis was performed using RevMan5.3 and Stata15 software.Result This study included 14 randomized controlled trials with a total of 932 patients.The results of Meta-analysis showed that the overall response rate(RR=1.42,95%CI:1.30-1.54,P<0.01)and the improvement rate of quality of life(RR=1.57,95%CI:1.27-1.94,P<0.01)in the experimental group were significantly higher than those in control group,and the level of vascular endothelial growth factor(VEGF)in pleural effusion in the experimental group was significantly lower than that in the control group(MD=-56.50,95%CI:-67.79--45.21,P<0.01).There were no significant differences in the incidence of gastrointestinal reactions,bone marrow suppression,abnormal liver and kidney function,hypertension and bleeding events between experimental group and control group(P>0.05).Conclusion Bevacizumab combined with cisplatin in the treatment of NSCLC with MPE can improve the efficacy and inhibit the formation of MPE without increasing the incidence of adverse events.