脑转移瘤治疗模式Meta分析与评价

摘要

Objective:To use Meta-analysis method to explore the best treatment of brain metastases. Methods:In Chinese and English keywords retrieval Cochrane,PubMed,ASCO,ESMO,SinoMed,Wangfan data,CNKI,retrieval time limit for the cases library database were built up to 2012-12-30. Results:Compared with monotherapy,com-bined therapy can improve survival rate in half year(RR=0. 75,95%CI:0. 66-0. 85,p<0. 00001). In the com-bined treatment group,compared with the two methods for combination therapy,three kinds of joint treatment can im-prove the half year survival rate of patients(RR=0. 59,95%CI:0. 47 -0. 74,p <0. 00001). Systemic +topical treatment compared with topical treatments can improve the survival rate of patients with brain metastases half year ( RR=0. 80,95%CI:0. 67-0. 96,p=0. 02). Systemic+topical treatment combined with systemic therapy compared to patients with brain metastases significantly increased half year survival rate(RR=0. 72,95%CI:0. 62-0. 84,p<0. 0001). In general and local treatment group,compared with two kinds of treatment methods,three kinds of treatment can improve the half year survival rate of patients(RR=0. 57,95%CI:0. 41-0. 78,p=0. 0005). Compared with no-molecular targeted drug therapy,molecular targeted therapy can improve the half year survival rate( RR=0. 90, 95%CI:0. 84-0. 96,p=0. 003). Conclusion:The reasonable treatment for patients with brain metastases was com-bined treatment with operation,radiotherapy,chemotherapy. Molecular targeted drugs were used,on the basis of orige-nal scheme,in patients with application of indications,have better effect.%目的：应用Meta分析的方法探讨脑转移瘤的最佳治疗模式。方法：以中英文关键词检索Cochrane、PubMed、ASCO、ESMO、中国生物医学文献数据库、万方数据库、CNKI，检索时限为自各数据库建库起至2013年12月30日。按照jadad评分评价文献质量，采用RevMan5.0软件完成统计分析。结果：综合治疗方式与单一治疗相比可以明显提高脑转移患者的半年生存率（ RR=0.75，95%CI：0.66-0.85，p<0.00001）。综合治疗组中，3种治疗方式联合与2种治疗方式联合相比脑转移患者的半年生存率明显提高（ RR=0.59，95%CI：0.47-0.74，p<0.00001）。全身+局部治疗方式与局部治疗相比可以提高脑转移患者的半年生存率（ RR=0.80，95%CI：0.67-0.96，p=0.02）。全身+局部联合治疗方式与全身治疗相比脑转移患者的半年生存率显著提高（RR=0.72，95%CI：0.62-0.84，p<0.0001）。全身+局部联合治疗组中，3种治疗方式联合与2种治疗方式联合相比脑转移患者的半年生存率明显提高（RR=0.57，95%CI：0.41-0.78，p=0.0005）。靶向药物治疗与非靶向治疗相比可以提高脑转移患者的半年生存率（ RR=0.90，95%CI：0.84-0.96，p=0.003）。结论：脑转移瘤的治疗模式为手术、化疗、放疗3种方式结合，具有靶向药物适应证的患者，在给予原方案基础上加用靶向治疗效果更佳，但不同治疗方式的选择时机及联合方式尚需进一步研究。