目的:系统评价血管内皮生长因子受体(vascular endothelial growth factor receptor,VEGFR)抑制剂在晚期胃癌治疗中的疗效及安全性.方法:检索PubMed、Cochrane Library、EMBase、ClinicalTrials.gov、万方数据库、中国知网、维普数据库等,查找含VEGFR抑制剂的治疗方案(试验组)与其他抗肿瘤药(对照组)治疗晚期胃癌的随机对照试验(randomized controlled trial,RCT),对符合标准的临床研究进行资料提取,应用 Stata 12.0软件进行文献荟萃(Meta)分析.其中,疗效的评价指标为总生存期、无进展生存期、疾病控制率、客观缓解率;安全性评价指标为Ⅲ级及以上不良反应发生情况.结果:最终入选8篇文献,共1 883例晚期胃癌患者.Meta分析结果显示,含VEGFR抑制剂组患者的总生存期(HR=0.74,P=0.035)和无进展生存期(HR=0.62,P=0.007)均较对照组明显延长,疾病控制率(RR=1.65,P<0.001)明显提高.不良反应方面,VEGFR抑制剂主要增加了患者蛋白尿(RR=4.43,P=0.043)、白细胞减少症(RR=2.29,P<0.001)和手足综合征(RR=7.70,P=0.005)的发生率.结论:VEGFR抑制剂可显著延长晚期胃癌患者的总生存期及无进展生存期,使患者有较大的生存获益,并可提高疾病控制率,但同时增加了蛋白尿、白细胞减少症和手足综合征的发生概率.%OBJECTIVE:To systematically review the efficacy and safety of vascular endothelial growth factor receptor inhibitor (VEGFR) in advanced gastric cancer. METHODS:Randomized controlled trials (RCTs) in treatment of advanced gastric cancer in treatment regimen consist of VEGFR inhibitor (experimental group) and other antitumor drugs(control group) were retrieved from PubMed, Cochrane Library, EMBase, ClinicalTrials.gov, Wanfang, CNKI and VIP database, clinical research accordance with the criteria were extracted, Stata 12.0 was adopted to conducted the Meta-analysis. Meanwhile, the evaluation indicators of efficacy were respectively overall survival, progression free survival, disease control rate and objective remission rate; while the evaluation indicators of safety were incidences of adverse drug reactions of third-level or above. RESULTS:Totally 8 literatures were involved, including 1 883 cases of advanced gastric cancer. According to Meta-analysis, the overall survival and progression free survival of VEGFR inhibitor were respectively (HR=0.74,P=0.035) and (HR=0.62,P=0.007), significantly longer than those of control group, the disease control rate increased significantly (RR=1.65,P<0.001). In term of adverse drug reactions, VEGFR inhibitor mainly increased the incidence of proteinuria (RR=4.43,P=0.043), leukopenia (RR=2.29,P<0.001) and hand-foot syndrome (RR=7.70,P=0.005). CONCLUSIONS:VEGFR inhibitor can effectively prolong the overall survival, progression free survival, which can make patients get larger survival benefits, and increase the disease control rate, yet also increase the incidence of proteinuria, leukopenia and hand-foot syndrome.
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