血管生成抑制剂联合化疗治疗复发性卵巢癌疗效与安全性Meta分析

摘要

Objective To study the efficacy and safety of angiogenesis inhibitors combined with chemotherapy in treatment of recurrent ovarian cancer.Methods The PubMed,Embase,The Cochrane Library,CBM,CNKI,VIP and Wan Fang Databases were electronically searched for publications from inception to January 2016 to collect randomized controlled trials (RCTs) about the efficacy and safety of angiogenesis inhibitors combined with chemotherapy in the treatment of patients with recurrent ovarian cancer and compared with routine chemotherapy.Literature data screening and bias risk assessing were independently executed by two reviewers.Meta-analysis was performed by Rev Man 5.3 software.Results Overall,6 RCTs involving 2028 recurrent ovarian cancer patients were included.The results were as follows:(1) OS and PFS for the angiogenesis inhibitors group was superior to the control group,respectively [HR=0.87,95％CI (0.76,0.99),P ＜ 0.05] and [HR=0.56,95 ％ CI (0.47,0.67),P ＜ 0.05].(2) There was no significant difference between two group in the total grade 3 or higher (P ＞ 0.05).Grade 3 or higher hypertension and proteinuria occurred more frequently in the anti-VEGF group(P ＜ 0.05).Grade 3 or higher proteinuria and grade 2 or lower diarrhea and nausea occurred more frequently in the anti-VEGFR group(P ＜ 0.05).More incidences of generalized edema occurred in the antiANG group (P ＜ 0.05).Conclusion Angiogenesis inhibitors combined with chemotherapy can improve OS and PFS.The total incidence of adverse reactions is similar to that of the routine chemotherapy group.The type and severity of adverse reactions are different in different mechanisms of angiogenesis inhibitors.%目的 探讨血管生成抑制剂联合化疗治疗复发性卵巢癌的疗效与安全性.方法 检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、维普与万方数据库,收集和评价国内外从建库至2016年1月血管生成抑制剂联合化疗与常规化疗相比较治疗复发性卵巢癌的疗效与安全性的随机对照试验(RCT).由2名研究者独立筛选提取文献资料、评价偏倚风险后,采用Rev Man5.3软件进行Meta分析.结果 共纳入6个RCT,2028例复发性卵巢癌患者.结果显示:(1)血管生成抑制剂联合化疗组较常规化疗组(对照组)可延长总生存期(OS)[HR=0.87,95％CI(0.76,0.99)]和无进展生存期(PFS) [HR=0.56,95％CI(O.47,0.67)],差异均有统计学意义(P＜0.05).(2)药物安全性结果显示:≥3级总不良反应发生率血管生成抑制剂联合化疗组与对照组间差异无统计学意义(P＞0.05),常见不良反应中抗血管内皮生长因子(anti-VEGF)抑制剂联合化疗组≥3级高血压、蛋白尿发生率较高;抗血管内皮生长因子受体(anti-VEGFR)抑制剂联合化疗组≥3级蛋白尿及≤2级腹泻、呕吐等不良反应发生率较高;抗促血管生成素(anti-ANG)抑制剂联合化疗组≤2级外周水肿发生率较高,以上差异均有统计学意义(P＜0.05).结论 血管生成抑制剂联合化疗可提高复发性卵巢癌患者OS及PFS,总不良反应发生率与常规化疗组相当.不同作用机制的血管生成抑制剂发生不良反应类型及严重程度具有一定差异.