个体化与固定剂量贝伐珠单抗联合顺铂灌注治疗恶性胸腔积液的有效性和安全性的网状meta分析OA
Efficiency and safety of individualized versus fixed-dose bevacizumab combined with cisplatin perfusion therapy for malignant pleural effusion:a network meta-analysis
目的 采用网状meta分析方法,比较个体化剂量(5 mg/kg)与固定剂量(300 mg)贝伐珠单抗联合顺铂胸腔灌注治疗非小细胞肺癌(NSCLC)合并恶性胸腔积液(MPE)的疗效及安全性差异,为临床精准用药提供循证依据.方法 系统检索PubMed、Embase、Cochrane Library、Web of Science、SinoMed、CNKI、VIP和WanFang Data数据库,收集2015 年 1 月至 2025 年 1 月发表的相关随机对照试验(RCT).由两名研究者独立完成文献筛选、数据提取及偏倚风险评估,采用RevMan 5.3 和Stata 18 软件进行网状meta分析.结果 共纳入 18 项RCT,涉及 1316 例患者.与顺铂单药相比,贝伐珠单抗个体化联合顺铂(OR=3.72,95%CI:2.70～5.13,P<0.001)和固定剂量联合顺铂(OR=3.69,95%CI:2.30～5.95,P<0.001)均能显著提高MPE治疗总有效率;SUCRA概率分析显示个体化方案疗效更优.两组治疗后胸腔积液VEGF水平均显著降低,个体化组WMD=-59.73,固定剂量组WMD=-54.75,SUCRA分析提示个体化方案降低VEGF水平的效果更显著.安全性方面,SUCRA概率分析显示个体化给药方案的肝肾功能异常、恶心呕吐、高血压及骨髓抑制等不良反应发生率均低于固定剂量组.结论 贝伐珠单抗 5 mg/kg个体化剂量联合顺铂胸腔灌注治疗NSCLC合并MPE,在疗效与安全性方面均略优于 300 mg固定剂量方案,有可能为患者带来更佳的综合临床获益.
Objective To compare the efficacy and safety of individualized(5 mg/kg)versus fixed-dose(300 mg)bev-acizumab combined with cisplatin intrapleural perfusion for non-small cell lung cancer(NSCLC)with malignant pleural effu-sion(MPE)using network meta-analysis,so as to provide evidence-based support for clinical precision medicine.Methods A systematic search was conducted across PubMed,Embase,Cochrane Library,Web of Science,SinoMed,CNKI,VIP,and WanFang Data databases to retrieve relevant randomized controlled trials(RCTs)published from January 2015 to Janu-ary 2025.Literature screening,data extraction,and bias risk assessment were independently conducted by two researchers,and network meta-analysis was performed by RevMan 5.3 and Stata 18.Results A total of 18 RCTs involving 1316 patients were included.Compared with cisplatin monotherapy,both personalized bevacizumab combined with cisplatin(OR=3.72,95％CI:2.70-5.13,P<0.001)and fixed-dose bevacizumab combined with cisplatin(OR=3.69,95％CI:2.30-5.95,P<0.001)significantly improved the overall response rate in the treatment of MPE,SUCR Aprobability analysis indi-cated that the individualized-dose regimen had superior efficacy.After treatment,the VEGF levels in pleural effusion signifi-cantly reduced in both groups.The WMD for the individualized group was-59.73,while the WMD for the fixed-dose group was-54.75.SUCRA analysis indicated that the individualized regimen had a more significant effect in reducing VEGF lev-els.In terms of safety,SUCRA probability analysis showed that the incidence of adverse reactions such as liver and kidney dysfunction,nausea and vomiting,hypertension,and bone marrow suppression was lower in the individualized dosing regi-men compared to the fixed-dose group.Conclusion Bevacizumab individualized regimen(5 mg/kg)combined with cispla-tin pleural perfusion demonstrates better effectiveness and safety profiles than the fixed-dose regimen(300 mg)for NSCLC with MPE,which potentially offers patients greater comprehensive clinical benefits.
李延秋;邹银水;毕桢干
湖北中医药大学第一临床学院,湖北 武汉 430060||湖北省中医院肿瘤科,湖北 武汉 430061||湖北中医药大学附属医院肿瘤科,湖北 武汉 430061||湖北省中医药研究院,湖北 武汉 430061||中医肝肾研究及应用湖北省重点实验室,湖北 武汉 430061湖北省中医院肿瘤科,湖北 武汉 430061||湖北中医药大学附属医院肿瘤科,湖北 武汉 430061||湖北省中医药研究院,湖北 武汉 430061||中医肝肾研究及应用湖北省重点实验室,湖北 武汉 430061湖北省中医院肿瘤科,湖北 武汉 430061||湖北中医药大学附属医院肿瘤科,湖北 武汉 430061||湖北省中医药研究院,湖北 武汉 430061||中医肝肾研究及应用湖北省重点实验室,湖北 武汉 430061
医药卫生
贝伐珠单抗顺铂非小细胞肺癌恶性胸腔积液网状meta分析随机对照试验
bevacizumabcisplatinnon-small cell lung cancer(NSCLC)malignant pleural effusion(MPE)network meta-analysisrandomized controlled trial(RCT)
《右江医学》 2026 (2)
172-180,9
湖北省重大疑难疾病中西医临床协作项目—乳腺癌方向(鄂卫通[2023]52)湖北省自然科学基金项目—基于中医"治未病"思想的胃癌风险预警模型构建(2024AFD277)
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