Chemoprevention of colorectal cancer in individuals with previous colorectal neoplasia: systematic review and network meta-analysis.
Chemoprevention of colorectal cancer in individuals with previous colorectal neoplasia: systematic review and network meta-analysis.
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DOI：
10.1136/bmj.i6188
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发表时间：
2016-12-05
期刊：
影响因子：
--
通讯作者：
Murad MH
中科院分区：
文献类型：
--
作者：
Dulai PS;Singh S;Marquez E;Khera R;Prokop LJ;Limburg PJ;Gupta S;Murad MH
目的评价候选药物的疗效和安全性（低剂量和高剂量阿司匹林、非阿司匹林、非甾体抗炎药（NSAID）、钙、维生素D、叶酸，单独或联合）用于预防晚期异时性瘤形成（即，在切除初始瘤形成后的不同时间发生），通过系统回顾和网络荟萃分析。数据来源Medline、Embase、Web of Science，从成立到2015年10月15日;临床试验登记。研究选择在既往结直肠肿瘤患者中进行的随机对照试验，接受候选化学预防药物治疗，并与安慰剂或其他候选药物进行比较。主要疗效结局为晚期异时性瘤形成的风险;安全性结局为严重不良事件。数据提取两名研究者确定研究和提取数据。进行贝叶斯网络荟萃分析，并使用累积排序下表面（SUCRA）概率（范围从1（表明治疗最佳的可能性很高）到0（表明治疗最差的可能性很高）评估药物的相对排序。采用GRADE标准评价证据质量。结果共纳入15个随机对照试验，共12 234例患者，比较了10种不同的治疗策略。与安慰剂相比，非阿司匹林NSAID预防晚期异时性肿瘤的效果最好（比值比0.37，95%可信区间0.24 - 0.53; SUCRA=0.98;高质量证据），其次是低剂量阿司匹林（0.71，0.41 - 1.23; SUCRA=0.67;低质量证据）。然而，低剂量阿司匹林在化学预防剂中排名最安全（0.78，0.43至1.38; SUCRA=0.84），而非阿司匹林NSAID（1.23，0.95至1.64; SUCRA=0.26）的安全性排名较低。高剂量阿司匹林的疗效与低剂量阿司匹林相当（1.12，0.59至2.10; SUCRA=0.58），但安全性较差（SUCRA=0.51）。无法估计药物降低异时性结直肠癌的疗效。结论在既往结直肠肿瘤患者中，非阿司匹林NSAID是预防晚期异时性肿瘤最有效的药物，而低剂量阿司匹林具有最有利的风险：获益特征。注册PROSPERO（CRD 42015029598）。
Objective To assess the comparative efficacy and safety of candidate agents (low and high dose aspirin, non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), calcium, vitamin D, folic acid, alone or in combination) for prevention of advanced metachronous neoplasia (that is, occurring at different times after resection of initial neoplasia) in individuals with previous colorectal neoplasia, through a systematic review and network meta-analysis. Data sources Medline, Embase, Web of Science, from inception to 15 October 2015; clinical trial registries. Study selection Randomized controlled trials in adults with previous colorectal neoplasia, treated with candidate chemoprevention agents, and compared with placebo or another candidate agent. Primary efficacy outcome was risk of advanced metachronous neoplasia; safety outcome was serious adverse events. Data extraction Two investigators identified studies and abstracted data. A Bayesian network meta-analysis was performed and relative ranking of agents was assessed with surface under the cumulative ranking (SUCRA) probabilities (ranging from 1, indicating that the treatment has a high likelihood to be best, to 0, indicating the treatment has a high likelihood to be worst). Quality of evidence was appraised with GRADE criteria. Results 15 randomized controlled trials (12 234 patients) comparing 10 different strategies were included. Compared with placebo, non-aspirin NSAIDs were ranked best for preventing advanced metachronous neoplasia (odds ratio 0.37, 95% credible interval 0.24 to 0.53; SUCRA=0.98; high quality evidence), followed by low-dose aspirin (0.71, 0.41 to 1.23; SUCRA=0.67; low quality evidence). Low dose aspirin, however, was ranked the safest among chemoprevention agents (0.78, 0.43 to 1.38; SUCRA=0.84), whereas non-aspirin NSAIDs (1.23, 0.95 to 1.64; SUCRA=0.26) were ranked low for safety. High dose aspirin was comparable with low dose aspirin in efficacy (1.12, 0.59 to 2.10; SUCRA=0.58) but had an inferior safety profile (SUCRA=0.51). Efficacy of agents for reducing metachronous colorectal cancer could not be estimated. Conclusions Among individuals with previous colorectal neoplasia, non-aspirin NSAIDs are the most effective agents for the prevention of advanced metachronous neoplasia, whereas low dose aspirin has the most favorable risk:benefit profile. Registration PROSPERO (CRD42015029598).
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影响因子：
3.4
作者：
Chu DZ;Hussey MA;Alberts DS;Meyskens FL Jr;Fenoglio-Preiser CM;Rivkin SE;Mills GM;Giguere JK;Blanke CD;Goodman GE
通讯作者：
Goodman GE
影响因子：
158.5
作者：
Bertagnolli, Monica M.;Eagle, Craig J.;Hawk, Ernest T.
通讯作者：
Hawk, Ernest T.
影响因子：
4.2
作者：
Bello, Alfonso E.;Holt, Robert J.
通讯作者：
Holt, Robert J.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
3.7
作者：
Chu, DZJ;Chansky, K;Lippman, SM
通讯作者：
Lippman, SM