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目的评价贝伐单抗联合化疗一线治疗转移性实体瘤的有效性和安全性。方法计算机检索Cochrane图书馆、PubMed、EMbase、CNKI、万方等数据库,收集贝伐单抗联合化疗一线治疗转移性实体瘤的随机对照试验,由2名研究者独立评价纳入研究的质量,采用RevMan 5.2软件进行Meta分析,主要结局指标包括无进展生存期(progression free survival,PFS)、总生存期(overall survival,OS)及毒性反应。结果共计16项随机对照试验纳入分析,包括6种恶性肿瘤和10917例病例;结果显示,与单纯化疗方案比较,贝伐单抗联合化疗一线治疗可以降低转移性实体瘤患者疾病进展风险(HR=0.70,95%CI:0.67~0.73,P<0.001)和疾病死亡风险(HR=0.89,95%CI:0.85~0.94,P<0.001),差异有统计学意义;在3~4级毒性反应方面,2组高血压(RR=6.58,95%CI:4.97~8.71,P<0.001)、蛋白尿(RR=10.85,95%CI:6.33~18.61,P<0.001)和出血(RR=1.76,95%CI:1.34~2.32,P<0.001)的发生率差异具有统计学意义,而静脉血栓栓塞(RR=1.00,95%CI:0.76~1.31,P=0.98)和动脉血栓栓塞(RR=1.28,95%CI:0.90~1.82,P=0.17)的发生率差异无统计学意义。结论贝伐单抗联合化疗一线治疗转移性实体瘤可延长患者无进展生存期和总生存期,但出现高血压、蛋白尿和出血的危险性更高,而不增加血栓栓塞的发生率。
Objective To evaluate the efficacy and safety of first-line bevacizumab in the treatment of metastatic solid tumors. METHODS: Randomized controlled trials of bevacizumab combined with first-line chemotherapy in the treatment of metastatic solid tumors were retrieved from the Cochrane Library, PubMed, EMbase, CNKI, Wanfang, etc. The quality of the included studies was independently evaluated by two investigators using RevMan Meta-analysis software 5.2, the main outcome measures include progression-free survival (progression free survival, PFS, overall survival (OS) and toxicity. Results A total of 16 randomized controlled trials were included in the analysis, including 6 malignant tumors and 10917 cases. The results showed that bevacizumab combined with first-line chemotherapy could reduce the risk of disease progression in patients with metastatic solid tumors (HR = 0.70, 95% CI: 0.67-0.73, P <0.001) and the risk of disease death (HR = 0.89,95% CI: 0.85-0.94, P <0.001). The difference was statistically significant. (RR = 6.58, 95% CI: 4.97-8.71, P <0.001), proteinuria (RR = 10.85, 95% CI: 6.33-18.61, P <0.001) and hemorrhage (RR = % CI: 1.34-2.32, P <0.001). There were significant differences in the incidence of venous thromboembolism (RR = 1.00,95% CI: 0.76-1.31, P = 0.98) and arterial thromboembolism 95% CI: 0.90-1.82, P = 0.17), the difference was not statistically significant. Conclusion Bevacizumab combined with first-line chemotherapy in the treatment of metastatic solid tumors can prolong the progression-free survival and overall survival of patients, but the risk of hypertension, proteinuria and bleeding is higher without increasing the incidence of thromboembolism.