紫杉醇联合奈达铂治疗卵巢癌的Meta分析
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摘要
目的:系统评价紫杉醇联合奈达铂对卵巢癌患者进行治疗的安全性和有效性。方法:计算机检索Pub Med、Cochrane Library、Embase、CNKI、Wan Fang Data、Sino Med数据库,搜集有关紫杉醇联合奈达铂治疗卵巢癌的随机对照试验(RCTs)。检索时限均为建库至2018年4月,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5. 3软件进行分析。结果:共纳入12项研究,包括1 219例患者。Meta分析结果显示,紫杉醇联合奈达铂治疗卵巢癌的总有效率与其他化疗方案相比,差异无统计学意义[OR=1. 14,95%CI (0. 88,1. 48),P=0. 16],但紫杉醇联合奈达铂可提高患者1年生存率[OR=3. 37,95%CI(1. 47,7. 71),P=0. 004]和2年生存率[OR=2. 24,95%CI(1. 27,3. 97),P=0. 006],并且该方案显著减少了不良反应的发生率:血小板降低[OR=0. 49,95%CI(0. 36,0. 66),P=0. 000 01]、恶心呕吐[OR=0. 65,95%CI(0. 47,0. 89),P=0. 007]、外周神经毒性[OR=0. 43,95%CI(0. 28,0. 67),P=0. 000 2]及肝功能损伤[OR=0. 39,95%CI(0. 20,0. 77),P=0. 006]等不良反应的发生率。结论:紫杉醇联合奈达铂治疗卵巢癌可延长患者1年及2年生存率且不良反应较轻,受研究数量和质量的限制,结论还需更多高质量的RCTs进行验证。
Objective: To systematically evaluate the efficacy and safety of paclitaxel combined with nedaplatin compared with other chemotherapeutics for ovarian cancer. Methods: The databases including Pub Med,Cochrane Library,Embase,CNKI,Wan Fang Data,Sino Med were electronically searched from inception to April 2018 to collect the randomized controlled trials( RCTs) about paclitaxel combining nedaplatin and other chemotherapeutics for ovarian cancer. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then Meta-analysis was performed by Rev Man 5. 3 software. Results: A total of 12 studies were included,involving 1 219 patients. The results of Meta-analysis showed that: paclitaxel combining nedaplatin had no significant difference in total effective rate( OR = 1. 14,95% CI 0. 88 to 1. 48,P = 0. 16),but this chemotherapy regimen significantly increased the 1-year survical rate( OR = 3. 37,95% CI 1. 47 to 7. 71,P = 0. 004) and 2-year survical rate( OR = 2. 24,95% CI 1. 27 to 3. 97,P =0. 006) compared with other chemotherapeutics. The occurrence of lower thrombocyte( OR = 0. 49,95% CI 0. 36 to 0. 66,P = 0. 000 01),vomiting adverse reaction( OR = 0. 65,95% CI 0. 47 to 0. 89,P = 0. 007),Peripheral neurotoxicity( OR= 0. 43,95% CI 0. 28 to 0. 67,P = 0. 000 2) and liver function damage( OR = 0. 39,95% CI 0. 20 to 0. 77,P = 0. 006)were also significantly decreased by using paclitaxel combining nedaplatin. Conclusion: Paclitaxel combined with nedaplatin for the treatment of ovarian cancer could reduce the toxic adverse effect while increasing the patient survival rate. The conclusion still need to be verified by more high-quality research due to limited sample size and quality in this study.
Objective: To systematically evaluate the efficacy and safety of paclitaxel combined with nedaplatin compared with other chemotherapeutics for ovarian cancer. Methods: The databases including Pub Med,Cochrane Library,Embase,CNKI,Wan Fang Data,Sino Med were electronically searched from inception to April 2018 to collect the randomized controlled trials( RCTs) about paclitaxel combining nedaplatin and other chemotherapeutics for ovarian cancer. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then Meta-analysis was performed by Rev Man 5. 3 software. Results: A total of 12 studies were included,involving 1 219 patients. The results of Meta-analysis showed that: paclitaxel combining nedaplatin had no significant difference in total effective rate( OR = 1. 14,95% CI 0. 88 to 1. 48,P = 0. 16),but this chemotherapy regimen significantly increased the 1-year survical rate( OR = 3. 37,95% CI 1. 47 to 7. 71,P = 0. 004) and 2-year survical rate( OR = 2. 24,95% CI 1. 27 to 3. 97,P =0. 006) compared with other chemotherapeutics. The occurrence of lower thrombocyte( OR = 0. 49,95% CI 0. 36 to 0. 66,P = 0. 000 01),vomiting adverse reaction( OR = 0. 65,95% CI 0. 47 to 0. 89,P = 0. 007),Peripheral neurotoxicity( OR= 0. 43,95% CI 0. 28 to 0. 67,P = 0. 000 2) and liver function damage( OR = 0. 39,95% CI 0. 20 to 0. 77,P = 0. 006)were also significantly decreased by using paclitaxel combining nedaplatin. Conclusion: Paclitaxel combined with nedaplatin for the treatment of ovarian cancer could reduce the toxic adverse effect while increasing the patient survival rate. The conclusion still need to be verified by more high-quality research due to limited sample size and quality in this study.
引文
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2 江希萍,徐云,郭彩霞.紫杉醇联合奈达铂治疗中晚期卵巢上皮性癌的疗效分析[J].临床和实验医学杂志,2013,12(22):1830-1832
3 孙欣欣,黄冬梅,刘玉玲.不同铂类联合紫杉烷在妇科恶性肿瘤化疗中的毒副反应对比分析[J].重庆医学,2012,41(23):2383-2385
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6 林仲秋,吴妙芳,李晶,等.《FIGO 2015妇癌报告》解读连载三——卵巢癌、输卵管癌、腹膜癌诊治指南解读[J].中国实用妇科与产科杂志,2015,31(12):1074-1081
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9 Li L,Zhuang QQ,Cao ZY,et al. Paclitaxel plus nedaplatin vs. paclitaxel plus carboplatin in women with epithelial ovarian cancer:A multi-center,randomized,open-label,phaseⅢtrial[J]. Oncol Lett,2018,15(3):3646-3652
10 王利君,王武亮.紫杉醇联合不同铂类药物化疗在晚期卵巢癌中的疗效和安全性探讨[J].现代诊断与治疗,2018,29(4):536-538
11 任红娟.紫杉醇脂质体多西他赛以及吉西他滨分别联合奈达铂治疗复发性卵巢癌的对比研究[C].湖北:2016《中国医院药学杂志》学术年会论文集,2016:351
12 孙玮.用不同的药物联合奈达铂治疗复发性卵巢癌的效果对比[J].当代医药论丛,2016,14(10):101-102
13 李波,肖凤仪,伍立群,等.奈达铂联合紫杉醇注射液对卵巢癌手术患者ROMA指数和HE4水平的影响[J].现代生物医学进展,2016,16(29):5752-5755
14 张慧君.洛铂联合吉西他滨治疗复发性卵巢癌36例临床分析[J].实用癌症杂志,2014,29(7):849-851
15 刘阳,王敏.紫杉醇联合奈达铂或卡铂治疗上皮性卵巢癌的临床疗效比较[J].现代药物与临床,2014,29(5):512-515
16 王双月.紫杉醇联合不同铂类药物化疗在晚期卵巢癌中的疗效和安全性研究[J].中国医学装备,2014,11(5):68-70
17 华瑛,姚安梅,杨浩.紫杉醇联合顺铂或奈达铂治疗晚期卵巢癌临床对比观察[J].陕西医学杂志,2013,42(11):1533-1534
18 张彬玉,不同药物联合奈达铂治疗复发性卵巢癌的疗效研究[D].山东泰安:泰山医学院硕士学位论文,2013
19 魏光敏.奈达铂联合化疗治疗中晚期卵巢上皮癌临床疗效观察[J].中国社区医师(综合版),2007,9(3):34
20 朱索宇,谭洁,张晨霞,等.力朴素联合奈达铂化疗对晚期卵巢癌患者血清HE4、CA125、CA19-9、AFP、CEA及T细胞亚群变化的影响[J].海南医学院学报,2016,22(15):1737-1740
21 沈剑钦.紫杉醇联合卡铂治疗晚期卵巢癌的临床疗效观察[J].中国医学工程,2013,21(12):68-72
22 吕靖,阚旋,英焕春,等.含奈达铂与含顺铂联合化疗治疗中晚期卵巢上皮癌[J].实用药物与临床,2009,12(1):4-5
23 何耿劲,赵慧慧.奈达铂治疗老年患者恶性腹水的疗效观察[J].实用老年医学,2015,29(4):342-343
2 江希萍,徐云,郭彩霞.紫杉醇联合奈达铂治疗中晚期卵巢上皮性癌的疗效分析[J].临床和实验医学杂志,2013,12(22):1830-1832
3 孙欣欣,黄冬梅,刘玉玲.不同铂类联合紫杉烷在妇科恶性肿瘤化疗中的毒副反应对比分析[J].重庆医学,2012,41(23):2383-2385
4 梁江红,冷小飞,程萍,等.紫杉醇剂量密度方案化疗在上皮性卵巢癌应用的疗效及安全性meta分析[J].现代妇产科进展,2015,24(6):416-420
5 Gong YL,Ren L,Zhou L,et al. Phase II evaluation of nedaplatin and paclitaxel in patients with metastatic esophageal carcinoma[J]. Cancer Chemother Pharmacol,2009,64(2):327-333
6 林仲秋,吴妙芳,李晶,等.《FIGO 2015妇癌报告》解读连载三——卵巢癌、输卵管癌、腹膜癌诊治指南解读[J].中国实用妇科与产科杂志,2015,31(12):1074-1081
7 糜若然,何晓音.妇科恶性肿瘤化疗的疗效评定标准[J].中级医刊,1997(10):14-16
8 Higgins JP,Altman DG,Gtzsche PC,et al. The Cochrane Collaborations tool for assessing risk of bias inrandomized trials[J]. BMJ,2011,343:d5928
9 Li L,Zhuang QQ,Cao ZY,et al. Paclitaxel plus nedaplatin vs. paclitaxel plus carboplatin in women with epithelial ovarian cancer:A multi-center,randomized,open-label,phaseⅢtrial[J]. Oncol Lett,2018,15(3):3646-3652
10 王利君,王武亮.紫杉醇联合不同铂类药物化疗在晚期卵巢癌中的疗效和安全性探讨[J].现代诊断与治疗,2018,29(4):536-538
11 任红娟.紫杉醇脂质体多西他赛以及吉西他滨分别联合奈达铂治疗复发性卵巢癌的对比研究[C].湖北:2016《中国医院药学杂志》学术年会论文集,2016:351
12 孙玮.用不同的药物联合奈达铂治疗复发性卵巢癌的效果对比[J].当代医药论丛,2016,14(10):101-102
13 李波,肖凤仪,伍立群,等.奈达铂联合紫杉醇注射液对卵巢癌手术患者ROMA指数和HE4水平的影响[J].现代生物医学进展,2016,16(29):5752-5755
14 张慧君.洛铂联合吉西他滨治疗复发性卵巢癌36例临床分析[J].实用癌症杂志,2014,29(7):849-851
15 刘阳,王敏.紫杉醇联合奈达铂或卡铂治疗上皮性卵巢癌的临床疗效比较[J].现代药物与临床,2014,29(5):512-515
16 王双月.紫杉醇联合不同铂类药物化疗在晚期卵巢癌中的疗效和安全性研究[J].中国医学装备,2014,11(5):68-70
17 华瑛,姚安梅,杨浩.紫杉醇联合顺铂或奈达铂治疗晚期卵巢癌临床对比观察[J].陕西医学杂志,2013,42(11):1533-1534
18 张彬玉,不同药物联合奈达铂治疗复发性卵巢癌的疗效研究[D].山东泰安:泰山医学院硕士学位论文,2013
19 魏光敏.奈达铂联合化疗治疗中晚期卵巢上皮癌临床疗效观察[J].中国社区医师(综合版),2007,9(3):34
20 朱索宇,谭洁,张晨霞,等.力朴素联合奈达铂化疗对晚期卵巢癌患者血清HE4、CA125、CA19-9、AFP、CEA及T细胞亚群变化的影响[J].海南医学院学报,2016,22(15):1737-1740
21 沈剑钦.紫杉醇联合卡铂治疗晚期卵巢癌的临床疗效观察[J].中国医学工程,2013,21(12):68-72
22 吕靖,阚旋,英焕春,等.含奈达铂与含顺铂联合化疗治疗中晚期卵巢上皮癌[J].实用药物与临床,2009,12(1):4-5
23 何耿劲,赵慧慧.奈达铂治疗老年患者恶性腹水的疗效观察[J].实用老年医学,2015,29(4):342-343