目的 系统分析比较奈达铂与顺铂在治疗局部晚期鼻咽癌的有效性和安全性。方法 计算机检索Cochrane Library、Pubmed、Embase、CNKI、VIP、WanFang data、CBM数据库,检索时限从建库至2015年4月,收集奈达铂化疗与顺铂化疗比较治疗局部晚期鼻咽癌的随机对照试验。由2名研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Revman 5.3软件进行Meta分析。结果 共纳入9个RCT,总计1 032例患者。Meta分析结果显示,奈达铂化疗方案的鼻咽原发病灶和颈部淋巴转移灶的缓解率及总缓解率与顺铂方案相当,在白细胞减少、肝功能损伤、神经毒性方面两者无统计学差异,而奈达铂方案的胃肠反应(恶心呕吐)的发生率低于顺铂方案(无统计学显著性差异),并能显著降低血红蛋白减少和肾功能损伤的发生率,但可能增加血小板减少的风险。结论 奈达铂化疗方案治疗局部晚期鼻咽癌的疗效与顺铂化疗方案相当,可显著降低贫血和肾功能损伤的风险,但可能增加出血风险。奈达铂可作为不能耐受顺铂不良反应的晚期鼻咽癌患者的替代治疗药物。
Abstract
OBJECTIVE To evaluate the effectiveness and safety of nedaplatin versus cisplatin in the treatment of local advanced nasopharyngeal carcinoma. METHODS Such databases as Cochrane Library, Pubmed, Embase, CNKI, VIP, WanFang data and CBM were searched from the date of their establishment to April 2015 to collect the randomized controlled trials on chemotherapy containing nedaplatin versus cisplatin for local advanced nasopharyngeal carcinoma. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the quality. The Meta-analysis was carried out by Revman 5.3 software. RESULTS A total of nine RCTs involving 1032 patients were included. The results of Meta-analysis suggested that, compared with cisplatin-containing chemotherapy, nedaplatin-containing chemotherapy had comparable short-term effects and similar incidences of leukopenia, liver function impairment and neurovirulence, and lower incidences of nausea and vomiting without statistically significant difference. Meanwhile nedaplatin-containing chemotherapy could significantly reduce the risk of anemia (RR=0.81, 95% CI 0.70 to 0.94, P=0.004) and renal function impairment (RR=0.35, 95% CI 0.19 to 0.67, P=0.001), but it was associated with higher risk of thrombocytopenia (RR=1.35, 95% CI 1.17 to 1.57, P<0.000 1). CONCLUSION Nedaplatin chemotherapy can be an alternative regimen to cisplatin chemotherapy for advanced nasopharyngeal carcinoma patients who are unable to tolerate the side effects of cisplatin.
关键词
奈达铂 /
顺铂 /
鼻咽癌 /
Meta分析 /
随机对照试验
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Key words
nedaplatin /
cisplatin /
nasopharyngeal carcinoma /
Meta-analysis /
randomized controlled trial
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中图分类号：
R969.3
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参考文献
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