胰腺癌患者体重丢失与预后及临床特征关系的系统评价

发布时间：2018-06-21 18:33

  本文选题：胰腺癌 + 体重丢失　； 参考：《皖南医学院》2017年硕士论文

【摘要】：目的:采用系统评价的方法探索体重丢失对胰腺癌患者预后、住院时间、生活质量及肿瘤特征等一系列临床特征的影响。方法:检索Pubmed、Embase、SCI-Ex-panded、Cochrane图书馆、相关期刊论文(China National Knowledge Infrastructure/Chinese Academic Journals Full-Text Database,CNKI)、中国生物医学文献数据库(Chinese Biomedical Database,CBM)、维普中文科技期刊数据库(Science and Technology Period Ical Database,VIP)及万方数据知识服务平台,同时检索正在进行的相关研究及会议文献,并对纳入文献的参考文献进行追踪分析。纳入研究为有关体重丢失与胰腺癌患者生存及一系列临床特征关系的相关文献。根据预先设定的纳入及排除标准,两名研究者单独对纳入的文献进行纳入排除及数据提取,并根据渥太华文献质量评估标准(Newcastle-Ottawa Quality Assessment Scale,NOS)评估纳入文献质量。采用Rev Man5.3软件进行数据综合及发表偏倚评估,根据数据综合结果的异质性大小决定采用固定(Fixed effects model,FE)或随机(Random effects model,RE)效应模型;同时对未能整合行meta分析的部分数据进行定性的分析评价。结果:共24篇文献符合纳入标准,其中10篇(1976例)可行meta分析,其余文献均分别进行描述性分析。结果显示:纳入meta分析的总人群中的总生存期(Overall Survival,OS)的合并危险比(Hazard Ratio,HR)为2.32(95%CI:1.21~4.47,P=0.01);体重丢失以百分比为划分标准的人群中,其OS的综合HR值为1.79(95%CI:1.07~3.01,P=0.03);以公斤数为划分标准的人群中,其综合的HR值为16.32(95%CI:10.4~25.6,P0.00001);以BMI指数减低为划分标准的人群中,其综合HR值为1.30(95%CI:1.06~1.60,P=0.01);纳入人群中1年生存率的综合风险比(Risk Ratio,RR)为0.66(95%CI:0.50~0.87,P=0.003)。亚组分析结果显示,体重丢失≥或10%的患者组与体重丢失≥5%或5%的患者组中,两组人群OS的综合HR值分别为1.93(95%CI:1.45~2.55,P0.00001)及3.03(95%CI:2.08~4.41,P0.00001);经手术治疗组及经放化疗治疗组中,两组人群OS的综合HR值分别为1.83(95%CI:1.39~2.41,P0.0001)及2.43(95%CI:1.07~5.50,P=0.03)。并且体重丢失与患者的PFS、MST、住院时间、KPS评分、生活质量、肿瘤的临床特征及放化疗反应的发生均有一定的相关性。结论:(1)Meta分析结果显示,胰腺癌患者中,体重丢失将缩短患者的OS;降低患者的1年生存率。(2)亚组分析显示,采用不同方式治疗的过程中,体重丢失均会导致患者的OS缩短。(3)体重丢失可延长患者的住院时间,降低患者的KPS评分、生活质量,并增加患者化疗副反应的发生率。
[Abstract]:Objective: to investigate the effects of weight loss on the prognosis, hospital stay, quality of life and tumor characteristics of patients with pancreatic cancer. Methods: the Pubmeda Embase SCI-Expanded Cochrane Library, the China National knowledge Infrastructure / Chinese Academic Journals Full-Text Database, the Chinese Biomedical Database CBMN, the Chinese Science and Technology period Ical Database VIPs, and the Wanfang data knowledge Service platform were searched in Pubmedus Embase, the Chinese Academic Journals Full-Text Database (CNKI), the Chinese Biomedical Database (CBM), the WIP Chinese Science and Technology periodical Database (Science and Technology period) and the Wanfang data knowledge Service platform. At the same time, the related research and conference documents are searched, and the references included in the literature are followed up. The study was included in the literature on the relationship between weight loss and survival and a range of clinical features in patients with pancreatic cancer. According to the pre-set inclusion and exclusion criteria, the two researchers separately excluded the included literature and extracted the data, and evaluated the literature quality according to the Ottawa document quality assessment standard, Newcastle-Ottawa quality Assessment scale notes. Rev Man5.3 software was used to evaluate data synthesis and publication bias. According to the heterogeneity of data synthesis results, fixed effects model (FEE) or random effects model (REE) effect model were adopted. At the same time, the qualitative analysis and evaluation of some data which can not be integrated with meta analysis are carried out. Results: a total of 24 articles met the inclusion criteria, of which 10 were eligible for meta analysis. The results showed that the overall survival rate of the total population included in the meta analysis was higher than that of Hazard Ratiohor (2.32 / 95 CI: 1.21: 4.47 P0.01a); the overall HR value of the population with weight loss as percentage was 1.7995 CI: 1.073.01P0.03; in the population with kilograms as the criterion, the overall HR value was 1.7995 CIW 1.073.01P0.03; and in the group with weight loss as a percentage, the overall HR value was 1.7995 CI: 1.073.01p 0.03; in the population whose weight was measured by the number of kg, the overall HR value of the population was 1.7995 CI: 1.073.01. Its comprehensive HR value was 16.32 / 95 CI: 10.4 25.6% P0.00001; in the population whose BMI index was reduced, the comprehensive HR value was 1.3095% (CI: 1.061.60), and the comprehensive risk ratio of 1-year survival rate was 0.66 95% 0.50% 0.50% 0.87P0. 0030.The total HR value was 0.66 95% 0.50% 0. 50% 0. 7% P = 0. 003, and the total HR value of 1 year survival rate was 0. 66% 95 CI: 0. 50% 0. 50% 0. 7% P = 0. 003. The results of subgroup analysis showed that in the patients with weight loss 鈮，

本文编号：2049627