作　　者： ; ; ;

机构地区： 广州中医药大学第一附属医院

出　　处： 《安徽医药》 2019年第12期2504-2510,共7页

摘　　要： 目的分析比较阿帕替尼联合经导管肝动脉灌注化疗栓塞(TACE)和单独应用TACE治疗中晚期原发性肝癌的临床疗效。方法利用计算机检索建库年至2018年11月间PubMed、Cochrane Library、Embase、中国知网(CNKI)、万方数据库、维普期刊及中国生物医学文献数据库(CBM)等数据库中关于比较阿帕替尼联合TACE与单纯TACE治疗原发性肝癌病人临床疗效及预后对照试验的相关文献报道。应用Review Manager(Version 5.3)软件,按照Cochrane协作网推荐的方法,对符合纳入标准的文献报道结果进行meta分析。结果本研究共纳入10项研究(8项随机对照试验及2项队列研究),共包括原发性肝癌病人716例。阿帕替尼联合TACE治疗中晚期原发性肝癌的客观缓解率(ORR)和疾病控制率(DCR)(ORORR=4.23,95%CI:2.19~8.18,P<0.01;ORDCR=5.38,95%CI:3.17~9.13,P<0.01)显著优越于单纯TACE治疗;TACE联合阿帕替尼治疗肝癌的6个月总体生存率、1年总体生存率、2年总体生存率明显优越于单独TACE治疗(OR6 m=2.88,95%CI:1.77~4.69,P<0.01;OR1 Y=2.25,95%CI:1.32~3.84,P<0.01;OR2 Y=3.10,95%CI:1.31~7.34,P=0.01);联合治疗组可以显著降低病人血清血管内皮生长因子(VEGF)和基质金属蛋白酶 9(MM 9)水平,且与对照组比较均差异有统计学意义(MDVEGF=-87.32,95%CI:-109.32^-65.33,P<0.01;MDMMP 9=-536.68,95%CI:-622.79^-450.57,P<0.01)。TACE联合阿帕替尼主要增加的并发症包括手足综合征、腹泻、高血压、蛋白尿、皮疹及瘙痒等,而发热、恶心呕吐、腹痛及骨髓抑制与单纯TACE治疗相比差异无统计学意义(P>0.05),严重不良反应均可通过对症处理有效控制。结论阿帕替尼联合TACE治疗中晚期原发性肝癌病人优于单独TACE疗法,可提高肝癌病人临床疗效及病人近期生存率。 Objective This meta analysis was to comprehensively compare the effectiveness of the combination of Apatinib and TACE with that of TACE alone for intermediated or advanced hepatocellular carcinoma( HCC).Met hods Using computer retrieval database construction between November 2018 and PubMed,Cochrane Library,Embase,China National Knowledge Internet (CNKI) 、Wan fang database、VIP journal and Chinese Biomedical Literature database( CBM) were used for searching literatures on the comparison of the effectiveness of the combination of Apatinib and TACE with that of TACE alone for the treatment of HCC. Review Manager( version 5.3) software from Cochrane Collaboration was used for this meta analysis.Results Eight randomized controlled trials and two cohort study were included in this meta analysis and totally included 716 HCC patients.The results of the meta analysis showed that the objective response rate and disease control rate(OR ORR=4.23, 95%CI:2.19~8.18,P <0.01;ORDCR= 5.38, 95%CI:3.17~9.13,P <0.01) and 6 month,1 year,2 year overall survival(OR 6 m=2 .88, 95%CI:1.77 4.69,P <0.01;OR1 Y= 2.25, 95%CI:1.32 3.84,P<0.01;OR2 Y=3 .10, 95%CI:1.31 7.34,P =0.01) of the combination of Apatinib and TACE were much better than that of TACE alone for the treatment of HCC.The level of vascular endothelial growth factor( VEGF)[MD VEGF=- 87.32, 95%CI:-109.32 -65.33,P <0 .01] and matrix metalloproteinase 9( MMP 9)[MD MMP 9=- 536.68, 95%CI:-622.79 -450.57,P <0.01]were markedly decreased and which was statistically different to control group.The incidence of Hand foot syndrome,diarrhea,hypertension,proteinuria,rash,pruritus were higher in the Apatinib with TACE group than in the TACE alone group.Conclusion The combination of Apatinib and TACE was associated with superior early treatment response and survival in comparison TACE monotherapy for patients with intermediated or advanced HCC.

关 键 词： 肝肿瘤 化学栓塞 治疗性 肝动脉 血管内皮生长因子类 基质金属蛋白酶 阿帕替尼 分析

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