复发性卵巢癌不同化疗方案临床疗效的Meta分析--2011中国医科大学附属盛京医院

临床应用研究/Meta梁媛1,刘佳丽2,张振勇1,吴荣11.中国医科大学附属盛京医院第二肿瘤科,辽宁沈阳1100222.中国医科大学附属第四医院肿瘤内科,辽宁沈阳110032SystemicreviewofefficacyandsafetyofchemotherapyinrefractoryandrelapsedovariancancerLIANGYuan1,LIUJiali2,ZHANGZhenyong1,WURong11.DepartmentofOncology,AffiliatedShengjingHospital,ChinaMedicalUniversity,Shenyang110022,P.R.China2.DepartmentofOncology,FourthAffiliatedHospital,ChinaMedicalUniversity,Shenyang110032,P.R.China:评价复发性卵巢癌不同化疗方案的临床疗效:计算机检索Cochrane图书馆MedlineEMBase及CBMDISC数据库,手工检索相关杂志会议论文学位论文等,追溯已获文献中的参考文献,收集复发性卵巢癌化疗相关的随机对照试验由2名评价员独立提取数据和评价纳入研究方法学质量Meta分析软件是由Cochrane协作网提供的RevMan5023:共纳入6篇英文文献,1117例患者,方法学质量评价1篇为A级,其余5篇为B级铂类敏感型患者化疗疗效的Meta分析结果显示,以卡铂为基础的联合化疗方案的PFS(HR=1.96,95%CI:1.69~2.29,P0.001)和OS(HR=1.79,95%CI:115~2.81,P=001)优于卡铂单药方案铂类耐药型患者化疗疗效的Meta分析结果显示,吉西他滨的PFS优于脂质体多柔比星(SMD=-1.45,95%CI:-5.93~-023,P=002),但脂质体多柔比星的OS优于吉西他滨(SMD=0.59,95%CI:0.34~085,P0.001);拓扑替康的PFS(SMD=174,95%CI:1.31~2.18,P0.001)和OS(SMD=173,95%CI:1.29~216,P0001)均优于曲奥舒凡:对于铂类敏感型复发性卵巢癌患者,推荐临床首选以卡铂为基础的联合化疗方案;对于铂类耐药型患者,应选择能诱导对铂类初始治疗已耐药的病灶发生反应的化疗方案如脂质体多柔比星拓扑替康及吉西他滨单药或联合化疗,2011,18(6):453-456[ABSTRACT]OBJECTIVE:Toevaluatethechemotherapyefficacyofdifferentchemotherapyregimensinrecurrentovariancancer.METHODS:TheCochraneLibraryMEDLINE,EMBASEandCBMDISCdatabasesweresearched.Relevantjournals,conferencepapers,thesisandreferencelistforrandomizedcontrolledtrialsofchemotherapyinrecurrentovariancancerwerealsosearchedbymanualretrieval.Tworeviewersindependentlyassessedtrialqualityandextracteddata.TheCochraneCollaborationssoftwareRevMan5.0.23wasusedformetaanalysis.RESULTS:SixEnglisharticlswereincluded(1117patients)andthemethodologicalqualitiesofonetrialwasgradeAandfiveweregradeB.TheMetaanalysisresultsofplatinumsensitivepatientsshowedthatthePFSandOSofcarboplatincombinationchemotherapywerebetterthanthatofcarboplatinsingleagentchemotherapy(HR=1.96,95%CI:1.69-2.29,P0.001;HR=1.79,95%CI:1.15-2.81,P=0.01).TheMetaanalysisresultsofplatinumresistantpatientsshowedthatgemcitabinewasbetterthanthatofpegylatedliposomaldoxorubicinonPFS(SMD=-1.45,95%CI:-5.93--0.23,P=0.02),whilepegylatedliposomaldoxorubicinwasbetterthanthatofgemcitabineonOS(SMD=0.59,95%CI:0.34-085,P0.001).TopotecanwasbetterthanthatoftreosulfanbothonPFSandOS(SMD=1.74,95%CI:131-2.18,P0001;SMD=1.73,95%CI:1.29-2.16,P0001).CONCLUSION:Basedontheavailableevidence,carboplatincombinationchemotherapyshouldberecommendedasthefirstclinicalchoiceforplatinumsensitivepatients,andpegylatedliposomaldoxorubicin,topotecanandgemcitabinemonotherapyorcombinationchemotherapyforplatinumresistantpatients.ChinJCancerPrevTreat,2011,18(6):453-456梁媛,女,辽宁抚顺人,主要从事恶性肿瘤的基础和临床研究工作Tel:86-24-96615-1-63215Email:[e-mail]吴荣,女,辽宁沈阳人,博士,教授,硕士生导师,主要从事恶性肿瘤放化疗的临床和基础研究工作Tel:86-24-96615-1-63215Email:[e-mail]45320113186CHINJCANCERPREVTREAT,March2011,Vol.18No.6卵巢肿瘤/药物疗法;肿瘤,复发;meta分析;治疗结果[KEYWORDS]ovarianneoplasms/drugtherapy;neoplasms,recurrence;Metaanalysis;treatmentontcomeR737.31A1673-5269(2011)06-0453-04,[1],,,:,6;,6[2],(randomizedcontrolledtrial,RCT),11.1Cochrane(20101)Medline(1978-2010)EMBase(1978-2010)CBMDISC(1978-2010),,;ovariantumorovariancancerrecurrentovariancancerchemotherapyrandomizedcontrolledtrials1.2RCT,;,;;301.32,,,Cochrane,5Jadad,1~2,3~51.4CochraneRevMan5.0.23Meta(relativerisk,RR)95%(confidenceinterval,CI);(standardmeandifference,SMD)(weightedmeandifference,WMD)(hazardrisk,HR)95%CI,,,[3]22.1175,103,66,6[49],1117(1)6RCT,;2[5,7],61[5]Jadad5,1[7]4,4[4,6,89]36RCT,1[5]A,5B2.2Meta2.2.13[6,89](progressionfreesurvivaltime,PFS)(overallsurvival,OS),MetaPFSOS,(HR=1.96,95%CI:1.69~2.29,P0.001)(HR=1.79,95%CI:1.15~2.81,P=0.01)Alberts[8]PFSOS,Meta(HR=1.80,95%CI:1.17~2.77,P=0.007),OS(HR=1.52,95%CI:0.95~244,P=0.08)Pfisterer[6]454,MetaPFSOS,PFSOS,(HR=172,95%CI:1.17~2.51,P=0.005)(HR=261,95%CI:1.99~3.42,P=0.005)Martin[9],PFS(HR=2.05,95%CI:1.72~2.46,P0.001),OS(HR=1.36,95%CI:0.94~1.97,P=0.10)1(n)(n)Mutch[4]20079996Ferrandina[5]20087677Pfisterer[6]2006178178+Meier[7]2009136138Alberts[8]20083130+Martin[9]20054038+2.2.22[45]PFSOS,MetaPFS(SMD=-1.45,95%CI:-593~-0.23,P=0.02),OS(SMD=0.59,95%CI:0.34~0.85,P0001)Meier[7]PFSOS,Meta,PFSOS,(SMD=1.74,95%CI:1.31~2.18,P0001)(SMD=1.73,95%CI:1.29~2.16,P0001)3,,,,[10],[11]:1);2);3),;4)6[12],,,[1314],,,,[13],,,,,,[9],,,,,,[1516],,,,,[17],,;,[17],,,;,,,RCT45520113186CHINJCANCERPREVTREAT,March2011,Vol.18No.6[1],,.[J].,2004,31(12):946949.[2],,.[J].,2007,14(2):173177.[3],.Meta[J].,2007,7(8):606613.[4]MutchDG,OrlandoM,GossT,etal.Randomizedphasetrialofgemcitabinecomparedwithpegylatedliposomaldoxorubicininpatientswithplatinumresistantovariancancer[J].JClinOncol,2007,25(19):28112818.[5]FerrandinaG,LudovisiM,LorussoD,etal.Phasetrialofgemcitabinecomparedwithpegylatedliposomaldoxorubicininprogressiveorrecurrentovariancancer[J].JClinOncol,2008,26(6):890896.[6]PfistererJ,PlanteM,VergoteI,etal.Gemcitabinepluscarboplatincomparedwithcarboplatininpatientswithplatinumsensitiverecurrentovariancancer:anintergrouptrialoftheAGOOVAR,theNCICCTG,andtheEORTCGCG[J].JClinOncol,2006,24(29):46994707.[7]MeierW,duBoisA,ReussA,etal.Topotecanvers