Antiangiogenesis therapy in ovarian cancer patients: An updated meta-analysis for 15 randomized controlled trials.
Antiangiogenesis therapy in ovarian cancer patients: An updated meta-analysis for 15 randomized controlled trials.
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卵巢癌患者的抗血管生成治疗：15 项随机对照试验的更新荟萃分析。
DOI：
10.1097/md.0000000000011920
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发表时间：
2018-08
期刊：
影响因子：
1.6
通讯作者：
Jiang J
中科院分区：
文献类型：
--
作者：
Jiang Y;Sun X;Kong B;Jiang J
补充数字内容可在文本中使用抗血管生成治疗已被证明可以延长自由生存期，毒性可耐受。然而，这些药物在总生存期（OS）中的疗效仍然存在争议。本研究旨在评估抗血管生成治疗在提高卵巢癌（OC）患者生存率方面的总体表现。检索PubMed、Embase、MEDLINE和科克伦对照试验中心的电子数据库，以确定2011年至2017年期间评估抗血管生成治疗在OC患者中的治疗价值的相关临床随机对照试验（RCT）。此外，还编写了年度会议摘要。只考虑英文文章。从合格的RCT中获得无进展生存期（PFS）、OS和客观缓解率（ORR）。本荟萃分析使用了至事件发生时间变量的HR和二分结局的OR及其95% CI。所有统计学分析均采用Stata 11.0软件进行，根据异质性采用固定或随机模型。本荟萃分析共纳入15项RCT，包括9359例患者。在总体分析中，与安慰剂或单独化疗相比，添加抗血管生成药物改善了PFS（HR = 0.71，95% CI 0.62 - 0.81，P <0.001）、OS（HR = 0.92，95% CI 0.86 - 0.98，P = 0.008）和ORR（OR = 1.74，95% CI 1.27 - 2.39，P = 0.001）。 抗血管生成药物延长了PFS（HR = 0.58，95%CI 0.52 - 0.65，P =.000）和OS（HR = 0.84，95% CI 0.76 - 0.92，P =.000），但仅PFS在初次治疗中（HR = 0.88，95% CI 0.79 - 0.98，P = 0.020），2例铂类药物敏感复发患者的PFS和OS较长（HR = 0.56，95% CI 0.48 - 0.64，P =.000，PFS; HR = 0.86，95% CI 0.76 - 0.98，P = 0.027，OS）以及铂类耐药复发病例（HR = 0.54，95% CI 0.41 - 0.71，P =.000，PFS; HR = 0.84，95% CI 0.71 - 0.98，P =.029，OS）。 在整个治疗过程中，PFS（HR = 0.66，95% CI 0.57 - 0.76，P <0.001）和OS（HR = 0.89，95% CI 0.83 - 0.96，P = 0.001）均有所改善。 然而，抗血管生成药物的维持治疗与更长的PFS或OS无关。基于现有的研究，抗血管生成药物在OC患者的生存中起重要作用。需要更多的随机对照试验才能得出更令人信服的结论。
Supplemental Digital Content is available in the text Antiangiogenesis therapy has been demonstrated to prolong the free survival with tolerable toxicity. However the efficacy of these drugs in overall survival (OS) remains controversial. This study was designed to assess the overall performance of antiangiogenesis therapy in improving the survival of ovary cancer (OC) patients. Electronic database of PubMed, Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched to identify relevant clinical randomized control trial (RCTs) assessing the therapeutic value of antiangiogenesis therapy in OC patients during 2011 to 2017. Additionally, abstracts of annual meetings were also conducted. Only English articles were considered. Progression free survival (PFS), OS, and objective response rate (ORR) were obtained from eligible RCTs. The HRs for time-to-event variables and ORs for dichotomous outcomes with their 95% CIs were used for this meta-analysis. All the statistical analyses were carried out by Stata 11.0 software using a fixed or random-models according to heterogeneity. A total of 15 RCTs including 9359 patients were recruited into this meta-analysis. Addition of antiangiogenic agents improved PFS (HR = 0.71, 95% CI 0.62–0.81, P < .001), OS (HR = 0.92, 95% CI 0.86–0.98, P = .008) and ORR (OR = 1.74, 95% CI 1.27–2.39, P = .001) compared to placebo or chemotherapy alone in overall analysis. Antiangiogenic agents prolonged both PFS (HR = 0.58, 95% CI 0.52–0.65, P = .000) and OS (HR=0.84, 95% CI 0.76–0.92, P = .000) in recurrent settings but only PFS in primary settings (HR = 0.88, 95% CI 0.79–0.98, P = .020), longer PFS and OS in both platinum-sensitive recurrent patients (HR = 0.56, 95% CI 0.48–0.64, P = .000, PFS; HR = 0.86, 95% CI 0.76–0.98, P = .027, OS) as well as platinum-resistant recurrent cases (HR = 0.54, 95% CI 0.41–0.71, P = .000, PFS; HR = 0.84, 95% CI 0.71–0.98, P = .029, OS). Throughout therapy improved PFS (HR = 0.66, 95% CI 0.57–0.76, P < .001) and OS (HR = 0.89, 95% CI 0.83–0.96, P = .001). However the maintenance therapy of antiangiogenic agents was irrelevant to a longer PFS or OS. Based on the available studies, antiangiogenic agents play an important role in the survival of OC patients. More randomized controlled trials are needed to reach more convinced conclusion.