摘要
目的采用网状meta分析方法,比较个体化剂量(5 mg/kg)与固定剂量(300 mg)贝伐珠单抗联合顺铂胸腔灌注治疗非小细胞肺癌(NSCLC)合并恶性胸腔积液(MPE)的疗效及安全性差异,为临床精准用药提供循证依据。方法系统检索PubMed、Embase、Cochrane Library、Web of Science、SinoMed、CNKI、VIP和WanFang Data数据库,收集2015年1月至2025年1月发表的相关随机对照试验(RCT)。由两名研究者独立完成文献筛选、数据提取及偏倚风险评估,采用RevMan 5.3和Stata 18软件进行网状meta分析。结果共纳入18项RCT,涉及1316例患者。与顺铂单药相比,贝伐珠单抗个体化联合顺铂(OR=3.72,95%CI:2.70~5.13,P<0.001)和固定剂量联合顺铂(OR=3.69,95%CI:2.30~5.95,P<0.001)均能显著提高MPE治疗总有效率;SUCRA概率分析显示个体化方案疗效更优。两组治疗后胸腔积液VEGF水平均显著降低,个体化组WMD=-59.73,固定剂量组WMD=-54.75,SUCRA分析提示个体化方案降低VEGF水平的效果更显著。安全性方面,SUCRA概率分析显示个体化给药方案的肝肾功能异常、恶心呕吐、高血压及骨髓抑制等不良反应发生率均低于固定剂量组。结论贝伐珠单抗5 mg/kg个体化剂量联合顺铂胸腔灌注治疗NSCLC合并MPE,在疗效与安全性方面均略优于300 mg固定剂量方案,有可能为患者带来更佳的综合临床获益。
Objective To compare the efficacy and safety of individualized(5 mg/kg)versus fixed-dose(300 mg)bevacizumab combined with cisplatin intrapleural perfusion for non-small cell lung cancer(NSCLC)with malignant pleural effusion(MPE)using network meta-analysis,so as to provide evidence-based support for clinical precision medicine.Methods A systematic search was conducted across PubMed,Embase,Cochrane Library,Web of Science,SinoMed,CNKI,VIP,and WanFang Data databases to retrieve relevant randomized controlled trials(RCTs)published from January 2015 to January 2025.Literature screening,data extraction,and bias risk assessment were independently conducted by two researchers,and network meta-analysis was performed by RevMan 5.3 and Stata 18.Results A total of 18 RCTs involving 1316 patients were included.Compared with cisplatin monotherapy,both personalized bevacizumab combined with cisplatin(OR=3.72,95%CI:2.70–5.13,P<0.001)and fixed-dose bevacizumab combined with cisplatin(OR=3.69,95%CI:2.30–5.95,P<0.001)significantly improved the overall response rate in the treatment of MPE,SUCRA probability analysis indicated that the individualized-dose regimen had superior efficacy.After treatment,the VEGF levels in pleural effusion significantly reduced in both groups.The WMD for the individualized group was-59.73,while the WMD for the fixed-dose group was-54.75.SUCRA analysis indicated that the individualized regimen had a more significant effect in reducing VEGF levels.In terms of safety,SUCRA probability analysis showed that the incidence of adverse reactions such as liver and kidney dysfunction,nausea and vomiting,hypertension,and bone marrow suppression was lower in the individualized dosing regimen compared to the fixed-dose group.Conclusion Bevacizumab individualized regimen(5 mg/kg)combined with cisplatin pleural perfusion demonstrates better effectiveness and safety profiles than the fixed-dose regimen(300 mg)for NSCLC with MPE,which potentially offers patients greater comprehensive clinical benefits.
作者
李延秋
邹银水
毕桢干
LI Yanqiu;ZOU Yinshui;BI Zhengan(The First Clinical College,Hubei University of Chinese Medicine,Wuhan 430060,Hubei,China;Department of Oncology,Hubei Provincial Hospital of TCM,Wuhan 430061,Hubei,China;Department of Oncology,Affiliated Hospital of Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China;Hubei Provincial Academy of Traditional Chinese Medicine,Wuhan 430061,Hubei,China;Hubei Provincial Key Laboratory of Traditional Chinese Medicine for Liver and Kidney Research and Application,Wuhan 430061,Hubei,China)
出处
《右江医学》
2026年第2期172-180,共9页
Chinese Youjiang Medical Journal
基金
湖北省重大疑难疾病中西医临床协作项目—乳腺癌方向(鄂卫通[2023]52)
湖北省自然科学基金项目—基于中医“治未病”思想的胃癌风险预警模型构建(2024AFD277)。
关键词
贝伐珠单抗
顺铂
非小细胞肺癌
恶性胸腔积液
网状meta分析
随机对照试验
bevacizumab
cisplatin
non-small cell lung cancer(NSCLC)
malignant pleural effusion(MPE)
network meta-analysis
randomized controlled trial(RCT)
