安罗替尼在治疗癌症患者中高血压的发生率和发生风险：一项系统评价和Meta分析

目的 为了明确癌症患者应用安罗替尼后高血压发生率和发生风险，同时比较安罗替尼与其他血管内皮生长因子受体（VEGFR）抑制剂之间高血压发生率的差异。方法 检索Pubmed、Cochrane Library、Embase、ASCO、中国知网、万方、维普和中国生物医学文献服务系统数据库，收集与安罗替尼相关的前瞻性Ⅱ期和Ⅲ期且有准确记录高血压不良反应发生情况的临床试验，采用R软件（3.6.0版本）对安罗替尼高血压不良反应发生率和发生风险进行Meta分析，使用SPSS软件（26.0版本）比较安罗替尼与其他VEGFR抑制剂之间高血压发生率的差异。结果 来自13项研究的1387名癌症患者被纳入Meta分析。使用安罗替尼的高血压总发生率约为47.1%（95% CI: 37.7%～56.6%），高等级高血压发生率约为10.6%（95% CI: 7.4%～14.2%），与安慰剂相比，安罗替尼可显著增加高血压发生风险（RR=5.58, 95% CI: 2.29～13.60, P<0.01）以及高等级高血压发生风险（RR=27.78, 95% CI: 3.56～216.86, P<0.01）。另外，安罗替尼高等级高血压发生率与阿昔替尼（RR=0.79, 95% CI: 0.61～1.02, P=0.066）和卡赞替尼（RR=0.87, 95% CI: 0.67～1.13, P=0.290）相似，其余均高于其他VEGFR抑制剂。结论 在使用安罗替尼的癌症患者中，高血压发生率较高，且显著增加发生高血压风险，建议临床对血压进行密切监测并及时治疗。

Incidence and risk of hypertension in cancer patients receiving anlotinib: Review and Meta-analysis

Objective To investigate the overall incidence and risk of hypertension in the treatment of cancer patients who receive anlotinib and compare the differences between anlotinib and other VEGFR inhibitors.Methods Pubmed, Embase, Cochrane Library, ASCO, CNKI, Wangfang, VIP and CBM databases were searched. Eligible studies were phase II and III prospective clinical trials on cancer patients who received anlotinib and had the hypertension data available. Meta-analysis for the incidence and risk of anlotinib was performed by using R software (version 3.6.0). SPSS software (version 26.0) was used to compare the difference between anlotinib and other VEGFR inhibitors.Results A total of 1387 cancer patients from 13 clinical trials were included in the Meta-analysis. The overall incidences of all grade and high grade hypertension in cancer patients who received anlotinib were about 47.1% (95%CI: 37.7%-56.6%) and 10.6% (95%CI: 7.4%-14.2%). The use of anlotinib was associated with significantly increased risk of all grade (RR=5.58, 95%CI: 2.29-13.60, P<0.01) and high grade hypertension (RR=27.78, 95%CI: 3.56-216.86, P<0.01). In addition, the incidence of high grade hypertension associated with anlotinib was similar to axitinib (RR=0.79, 95%CI: 0.61-1.02, P=0.066) and cabozantinib (RR=0.87, 95%CI: 0.67-1.13, P=0.290). The incidences of rest of other VEGFR inhibitors were lower than that of anlotinib.Conclusions There is a high incidence and significant risk of developing hypertension in cancer patients receiving anlotinib. Adequate monitoring and timely treatment of hypertension is recommended.