摘要
目的系统分析白蛋白结合型紫杉醇联合吉西他滨化疗方案在治疗进展期胰腺癌方面的临床效果,为临床决策更好的制订提供依据。方法以英文检索词:pancreatic cancer,gemcitabine,nab-paclitaxel and abraxane和中文检索词:胰腺癌、吉西他滨及白蛋白结合型紫杉醇等对中国生物医学文献数据库、中国知网、万方数据资源库、维普数据库、PubMed、Embase、Cochrane Library、Web of Science等数据库进行检索,检索出从建库至2018年10月的中英文文献。依据文献纳入与排除标准,筛选出合适的临床研究文献,提取数据并行文献质量评价,应用RevMan5. 3统计软件进行分析。结果共纳入10篇临床研究文献,总计2908例患者,其中试验组(白蛋白结合型紫杉醇联合吉西他滨) 1633例,对照组(FOLFIRINOX) 1275例。Meta分析结果显示,试验组药物毒副作用发生率,如疲乏[比值比(OR)=0. 61,95%可信区间(95%CI)=0. 46～0. 80,P=0. 0005]、腹泻(OR=0. 39,95%CI:0. 29～0. 54,P <0. 001)、恶心呕吐(OR=0. 46,95%CI:0. 26～0. 84,P=0. 01)、3～4级中性粒细胞减少(OR=0. 61,95%CI:0. 43～0. 88,P=0. 007)以及需要二线方案治疗率(OR=0. 30,95%CI:0. 14～0. 63,P=0. 001)均低于对照组。而2组在疾病缓解率(OR=0. 82,95%CI:0. 45～1. 51,P=0. 53)、疾病控制率(OR=0. 97,95%CI:0. 48～1. 97,P=0. 93)、1年生存率(OR=0. 80,95%CI:0. 63～1. 01,P=0. 06)以及新辅助化疗后术后并发症的发生率(OR=1. 84,95%CI:0. 33～10. 19,P=0. 49)方面差异均无统计学意义。结论白蛋白结合型紫杉醇联合吉西他滨化疗方案在不增加药物毒副作用的同时,可提高进展期胰腺癌的临床治疗效果,表现出较好的临床安全性和有效性。
Objective To investigate the clinical effect of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) combined with gemcitabine in the treatment of advanced pancreatic cancer,and to provide a basis for making better clinical decisions. Methods CBM,CNKI,Wanfang Data,VIP,PubMed,Embase,Cochrane Library,and Web of Science were searched for Chinese and English articles published up to October 2018,with English keywords of “pancreatic cancer”,“gemcitabine”,“nab-paclitaxel”,and “abraxane” and Chinese keywords of “pancreatic cancer”,“gemcitabine”,and “nanoparticle albumin-bound paclitaxel”(in Chinese). Appropriate clinical trials were screened out according to the inclusion and exclusion criteria. Then,the data were extracted and quality assessment was performed. RevMan 5.3 software was used to perform the meta-analysis. Results A total of 10 clinical trials were included,with a total of 2908 patients. There were 1633 patients in the study group (treated with nab-paclitaxel combined with gemcitabine) and 1275 patients in the control group (treated with FOLFIRINOX). The results of the meta-analysis showed that compared with the control group,the study group had significantly lower incidence rates of drug side-effects such as fatigue (odds ratio [OR]=0.61,95% confidence interval [CI]: 0.46-0.80,P =0.0005),diarrhea (OR=0.39,95% CI: 0.29-0.54,P <0.001),nausea and vomiting (OR=0.46,95% CI: 0.26-0.84,P =0.01),and grade 3-4 neutropenia (OR=0.61,95% CI: 0.43-0.88,P =0.007),as well as a significantly lower rate of second-line treatment (OR=0.30,95% CI: 0.14-0.63,P =0.001). There were no significant differences between the two groups in disease remission rate (OR=0.82,95% CI: 0.45-1.51,P =0.53),disease control rate (OR=0.97,95% CI: 0.48-1.97,P =0.93),1-year survival rate (OR=0.80,95% CI: 0.63-1.01,P =0.06),and incidence rate of complications after neoadjuvant chemotherapy (OR=1.84,95% CI: 0.33-10.19,P =0.49). Conclusion Nab-paclitaxel combined with gemcitabine can improve the clinical outcome of advanced pancreatic cancer without increasing drug adverse events,and therefore,it has good safety and efficacy in clinical practice.
作者
王芸
张耕源
罗长江
杨含腾
WANG Yun;ZHANG Gengyuan;LUO Changjiang(Department of Chemotherapy,Wuwei Cancer Hospital of Gansu Province,Wuwei,Gansu 733000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2019年第5期1041-1046,共6页
Journal of Clinical Hepatology
基金
甘肃省卫生厅行业计划项目(GZK-2016-33)
关键词
胰腺肿瘤
白蛋白结合型紫杉醇
抗肿瘤联合化疗方案
META分析
pancreatic neoplasms
albumin-bound paclitaxel
antineoplastic combined chemotherapy protocols
Meta-analysis
