干扰素α联合化疗治疗转移性黑色素瘤疗效的Meta分析

发布时间：2018-06-14 09:46

本文选题：转移性黑色素瘤 + 干扰素α　；参考：《郑州大学》2017年硕士论文

【摘要】：背景恶性黑色素瘤是一种来源自神经嵴黑色素细胞的恶性肿瘤,其恶性程度非常高,临床预后较差。对于转移性黑色素瘤来说,其五年存活率可低至10%,目前尚无有效的治疗手段,经典的治疗方法是细胞毒性化疗,但其有效率较低,且伴有明显毒副反应。随着免疫遗传学的快速发展,转移性黑色素瘤的全身治疗方法也有了新的进展,免疫治疗已成为目前的研究热点。有学者发现将免疫治疗联合化疗药物应用(即生物化疗)能够提高疗效。已有多项随机对照试验探究免疫细胞因子干扰素α联合化疗与单纯化疗之间的差异,尽管结果不尽相同,但许多人认为生物化疗可以增加相关反应率,同时也增加了毒副反应。为了获得一个不偏不倚和可靠的真实效益评估,本文对干扰素α联合化疗治疗转移性黑色素瘤的相关随机试验进行了荟萃分析。目的通过与单纯化疗相对比,对干扰素α联合化疗治疗转移性黑色素瘤的临床疗效和安全性进行系统评价。方法计算机系统检索PubMed,MEDLINE,EMBASE,The Cochrane Library,中国知网、维普中文科技期刊、万方数据库自建库起截止到2016年9月的相关文献,根据制定的纳入标准和排除标准进行筛选,并对最终纳入的文献结果应用RevMan 5.3进行Meta分析,使用相对危险度(RR)和95%置信区间(95%CI)来计算有效率、总体生存率和毒副反应。结果一共纳入了14篇随机对照研究,共涉及1708例转移性黑色素瘤患者,其中IFN-α联合化疗组897例,单纯化疗组811例。与单纯化疗相比,IFN-α联合化疗可以提高转移性黑色素瘤患者的完全缓解率(RR=2.97,95%CI=1.89-4.67,P0.00001)、部分缓解率(RR=1.31,95%CI=1.05-1.64,P=0.02)和总有效率(RR=1.59,95%CI=1.32-1.92,P0.00001);而两组的1年总体生存率(RR=1.08,95%CI=0.90-1.30,P=0.39)、3年总体生存率(RR=1.44,95%CI=0.82-2.54,P=0.20)均无统计学差异;IFN-α联合化疗的血液系统反应(RR=1.44,95%CI=0.63-3.28,P=0.38)、恶心和呕吐反应(RR=1.03,95%CI=0.78-1.35,P=0.86)无显著增加,而药物性发热反应(RR=4.06,95%CI 1.67-9.87,P=0.002)的发生率明显增加。结论1.与单纯化疗相比,IFN-α联合化疗可以提高转移性黑色素瘤患者的完全缓解率、部分缓解率和总有效率,但不能改善患者的1年、3年总体生存率。2.与单纯化疗相比,IFN-α联合化疗没有增加转移性黑色素瘤患者的血液系统毒副反应、恶心和呕吐反应,但药物性发热的发生率明显增高。
[Abstract]:Background malignant melanoma is a malignant tumor derived from neural crest melanocytes. Its malignant degree is very high and its clinical prognosis is poor. For metastatic melanoma, the 5-year survival rate can be as low as 10 years, and there is no effective treatment. The classical treatment is cytotoxic chemotherapy, but its effective rate is low, and it has obvious side effects. With the rapid development of immunogenetics, systemic treatment of metastatic melanoma has made new progress, immunotherapy has become a hot topic. Some researchers have found that immunotherapy combined with chemotherapeutic drugs (i.e. biochemotherapy) can improve the efficacy. A number of randomized controlled trials have been conducted to explore the difference between immunocyte factor interferon 伪 combination chemotherapy and chemotherapy alone. Although the results are not the same, many people think that biochemotherapy can increase the response rate, but also increase the toxic side effects. In order to obtain an impartial and reliable evaluation of the true benefit, a meta-analysis of the randomized trials of interferon 伪 combined chemotherapy in the treatment of metastatic melanoma was carried out. Objective to evaluate the efficacy and safety of interferon-伪 combined chemotherapy in the treatment of metastatic melanoma. Methods A computer system was used to search the relevant documents of PubMedus MEDLINE EMBASEN the Cochrane Library, Chinese Journal of Science and Technology of Weipu, and Wanfang database, and to screen them according to the inclusion criteria and exclusion criteria. Meta-analysis was performed with RevMan 5.3 and the relative risk (RR) and 95% confidence interval (95% CI) were used to calculate the effective rate, overall survival rate and toxicity. Results A total of 14 randomized controlled studies were conducted, involving 1708 patients with metastatic melanoma, including 897 cases in IFN- 伪 combined chemotherapy group and 811 cases in simple chemotherapy group. Compared with chemotherapy alone, combination chemotherapy with IFN- 伪 can improve the complete remission rate of metastatic melanoma patients and the overall 1 year overall survival rate of the two groups is not significantly different from that of the patients with metastatic melanoma. The overall 1 year overall survival rate is 0.90-1.30P0.39, and the overall 3-year survival rate is higher than that of the RRR1.3195CII 1.05-1.64P0.02) and the total effective rate RR1.5995CII 1.32-1.92P0.00001. There is no statistical difference between the two groups in the 1-year overall survival rate of RR1.08-95CI0.9CI0.90-1.30P0.39, and the 3-year overall survival rate of RR1.449595 ~ 0.82-2.54P0.20. There is no statistical difference between the two groups in the overall survival rate of RR1.08-95CII (0.90-1.30P0.39) and the overall 3-year survival rate of RRN- 伪 (1.39595 CI 1.05-1.64P0.02). The blood system response of IFN- 伪 in combination chemotherapy was not significantly increased, but no significant increase was found in the blood system reaction of RRN- 伪 combined chemotherapy and CI0.63-3.28 P0. 38%, and the nausea and vomiting response of RRN 1.0395% CI0.78-1.35 P0. 86). However, the incidence of drug induced fever was significantly increased in RRX 4.0695 CI 1.67-9.87 P0. 002. Conclusion 1. Compared with chemotherapy alone, combination chemotherapy with IFN- 伪 can improve the complete remission rate, partial remission rate and total effective rate of metastatic melanoma patients, but it can not improve the overall survival rate of 1 year and 3 years in patients with metastatic melanoma. Compared with chemotherapy alone, combination chemotherapy with IFN- 伪 did not increase the toxic side effects, nausea and vomiting in the blood system of patients with metastatic melanoma, but the incidence of drug-induced fever was significantly higher.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.5

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