【摘要】 目的系统评价阿帕替尼联合经导管肝动脉化疗栓塞(TACE)治疗中晚期肝癌的疗效与安全性。方法检索The Cochrane Library、Embase、PubMed、中国生物医学文献数据库、中国知网、万方数据库、维普中文科技期刊数据库自建库至2019年10月收录的关于阿帕替尼联合TACE治疗中晚期肝癌的随机对照试验(RCTs),由两位研究者按照纳入与排除标准独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入17个RCTs。阿帕替尼组客观缓解率(RR=1.76,95%CI:1.37～2.26,P<0.001)、1年生存率(RR=1.55,95%CI:1.27～1.89,P<0.001)和2年生存率(RR=1.69,95%CI:1.20～2.39,P=0.003)均显著高于对照组;阿帕替尼组患者骨髓抑制发生率(RR=0.97,95%CI:0.69～1.36,P=0.84)、高血压发生率(RR=7.62,95%CI:4.48～12.96,P<0.001)、手足综合征发生率(RR=14.32,95%CI:6.18～33.21,P<0.001)、蛋白尿发生率(RR=9.18,95%CI:4.34～19.41,P<0.001)均高于对照组。结论当前证据表明,阿帕替尼可显著提高肝癌患者的客观缓解率和生存率,同时也可增加骨髓抑制、高血压、手足综合征、蛋白尿的发生率,但大多数患者经对症处理后可好转,因此临床使用时可进行综合考虑。更多还原

【Abstract】 Objective To systematically assess the effectiveness and safety of apatinib combined with transcatheter arterial chemoembolization in the treatment of moderate and advanced liver cancer. Methods Databases including the Cochrane Library, Embase, PubMed, CBM, CNKI, WanFang Data and VIP were electronically retrieved from inception to Oct.2019 for randomized controlled trials(RCTs) on apatinib combined with transcatheter arterial chemoembolization in the treatment of moderate and advanced liver cancer. Two reviewers independently screened the literatures, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2.3 software. Results Seventeen RCTs were included. The results of meta-analysis indicated that, compared with the control group, apatinib group could improve its objective response rate(RR=1.76, 95% CI: 1.37～2.26, P<0.001), one-year survival rate(RR=1.55, 95% CI: 1.27～1.89, P<0.001), two-year survival rate(RR=1.69, 95% CI: 1.20～2.39, P=0.003). The incidence of myelosuppression(RR=0.97, 95% CI: 0.69～1.36, P=0.84), hypertension(RR=7.62, 95% CI: 4.48～12.96, P<0.001), hand-foot syndrome(RR=14.32, 95% CI: 6.18～33.21, P<0.001), proteinuria(RR=9.18, 95% CI: 4.34～19.41, P<0.001) were all higher than those of the control group. And the differences were statistically significant except that in incidence of myelosuppression. Conclusion Current evidence shows that apatinib can improve the objective remission rate and survival rate of liver cancer patients. But it can also increase the incidence of myelosuppression, hypertension, hand-foot syndrome, proteinuria. Though most patients can turn better after symptomatic treatment, it is better to take overall consideration in clinical practice.更多还原