替莫唑胺对比传统化疗药治疗高级别脑胶质瘤的循证研究

发布时间：2018-05-24 03:58

本文选题：胶质瘤 + 替莫唑胺　；参考：《兰州大学》2014年硕士论文

【摘要】：目的脑胶质瘤是最常见的颅内原发性肿瘤,大多为浸润性生长。根据2011年美国脑肿瘤登记报告,大约40%的中枢神经系统肿瘤为高级别恶性肿瘤。目前国内外治疗脑胶质瘤的原则主要是以手术为基础联合放化疗的综合治疗。当前化疗药物众多,目前还没有标准的化疗方案。本研究在对替莫唑胺(Temozolomide, TMZ)与传统化疗药治疗高级别脑胶质瘤的有效性和安全性进行系统评价的基础上,利用历史性队列研究方法收集TMZ方案(TMZ同步放化疗加后续TMZ辅助化疗)和传统化疗药替尼泊苷(Teniposide,VM-26)联合顺铂(Cisplatin,DDP)方案(VP方案)治疗高级别脑胶质瘤的临床资料,分析比较两组药物临床疗效,从而为临床决策提供证据参考。方法①计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库、相关期刊论文、中华医学会数字化期刊,纳入TMZ对比传统化疗药治疗脑胶质瘤的随机对照试验(Randomized Controlled Trial,RCT),检索时间截至2013年12月。采用质量评价工具评价纳入研究质量；②采用历史性队列研究方法,客观评价TMZ方案和VP方案治疗脑胶质瘤的临床疗效及经济学指标。使用SPSS19.0软件进行统计分析。结果①研究纳入8个RCTs,864例患者,其中TMZ组374例,传统化疗药物组490例。Meta分析结果显示,在治疗有效率[RR=1.48,95%CI(1.24,1.77)]、5年生存率[HR=23.94,95%CI(13.26,43.22)]、无进展生存期[MD=4.00,95%CI(2.61,5.39)]、平均生存期[SMD=1.84,95%CI(1.40,2.27)]、消化道反应[RR=0.53,95%CI(0.39,0.71)]和骨髓抑制[RR=0.20,95%CI(0.08,0.51)]等方面两组差异均有统计学意义,TMZ组优于传统化疗药组；②历史性队列研究共纳入患者31例,TMZ组16例,VP组15例,研究结果提示：TMZ组与VP组的近期疗效无明显统计学差异,而TMZ组在单次平均总住院费用及单次化疗平均住院费用上高于VP组,Cox回归分析提示年龄与病理分级是脑胶质瘤患者预后的独立影响因素。结论①系统评价研究显示,两组化疗方案在治疗高级别脑胶质瘤的比较上,TMZ组化疗效果优于传统化疗药组；②历史性队列研究提示TMZ组与VP组对于高级别脑胶质瘤的治疗效果相当,但TMZ组经济学负担更重。由于回顾性研究的自身局限性,结论有待于大样本、随访时间长的研究来进一步验证。
[Abstract]:Objective glioma is the most common primary intracranial tumor, mostly invasive growth. According to the 2011 U.S. brain Cancer Registry, about 40 percent of central nervous system tumors are high-grade malignancies. At present, the principle of glioma treatment at home and abroad is based on surgery combined with radiotherapy and chemotherapy. There are many chemotherapeutic drugs and there is no standard chemotherapy regimen. This study was based on a systematic evaluation of the efficacy and safety of temozolomide (TMZ) and traditional chemotherapeutic agents in the treatment of high-grade gliomas. A historical cohort study was used to collect the clinical data of TMZ regimen combined with TMZ adjuvant chemotherapy and teniposide Teniposidede VM-26 (combined with cisplatin Cisplatinine) regimen (VP regimen) in the treatment of high grade gliomas. To analyze and compare the clinical efficacy of the two groups of drugs, so as to provide evidence for clinical decision-making. Methods 1 A computer-based search was conducted for PubMedus EMBASE Cochrane Library, Chinese Biomedical Literature Database, Chinese Sci-tech Journal Full-text Database, Chinese Journal Full-text Database and Chinese Medical Association Digital Journal. A randomized controlled trial of TMZ was used to treat gliomas compared with traditional chemotherapeutic agents. The search time was up to December 2013. To evaluate the clinical efficacy and economic indexes of TMZ regimen and VP regimen in the treatment of glioma. Use SPSS19.0 software for statistical analysis. Results 1 the study included 864 patients with RCTsN, including 374 patients in TMZ group and 490 patients in traditional chemotherapeutic drugs group. There were significant differences between the two groups in the effective rate [RRN 1.4895 CII 1.241.77], 5-year survival rate (HR23.9495 CI 13.262643.22), progression-free survival (MD4.00 / 95CI2.61 / 5.39), mean survival [SMD1.895CI1.402.27], digestive tract reaction (RRN0.5395CI0.39 / 0.71) and bone marrow suppression (RRR0.2095CI0.080.51). 2 the historical cohort study included 31 patients with TMZ and 16 patients with VP. The results showed that there was no significant difference in the short-term curative effect between the two groups. However, the average total hospitalization cost and average hospitalization cost of single chemotherapy in TMZ group were higher than those in VP group, which indicated that age and pathological grade were independent factors for prognosis of glioma patients. Conclusion (1) systematic evaluation study showed that the chemotherapy effect of TMZ group was better than that of traditional chemotherapy group in the treatment of high-grade glioma. 2 the historical cohort study showed that TMZ group and VP group had the same therapeutic effect for high grade glioma, but the TMZ group had more economic burden. Due to the limitations of the retrospective study, the conclusions need to be further verified by a large sample and a long follow-up study.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

【参考文献】