聚ADP核糖聚合酶抑制剂治疗复发性卵巢癌的系统评价

目的 研究聚ADP核糖聚合酶(PARP)抑制剂治疗复发性卵巢癌的疗效和安全性.方法 采用Cochrane系统评价方法,检索Medline、Embase、Central和中国生物医学文献数据库,检索时限为建库至2017年9月,手工检索相关参考文献,纳入PARP抑制剂治疗复发性卵巢癌的随机对照试验(RCT).应用RevMan5.3软件进行Meta分析.结果 纳入5个RCT,试验组患者1 160例,对照组患者679例.PARP抑制剂治疗较安慰剂明显改善无进展生存HR =0.34,95％CI(0.30,0.40),P＜0.01]和总生存结局HR=0.73,95％CI(0.55,0.96),P=0.025],增加客观反应率RR=2.56,95 ％CI(1.17,5.59),P=0.020].与单用化疗相比,PARP抑制剂+化疗明显降低疾病进展风险HR=0.51,95％CI(0.34,0.77),P=0.001],但总生存结局HR=1.17,95 ％CI(0.79,1.73),P=0.440]和客观反应率RR=1.11,95％CI(0.86,1.42),P=0.420]在两组间的差异无统计学意义.PARP抑制剂治疗明显增加严重贫血、疲劳、恶心及呕吐的发生率.结论 现有证据表明PARP抑制剂能改善复发性卵巢癌的无进展生存结局.

Systematic review on poly ADP ribose polymerase inhibitors for treating recurrent ovarian cancer

Objective To evaluate the efficacy and safety of poly ADP ribose polymerase (PARP) inhibitors for treating recurrent ovarian cancer.Methods The databases of Medline,Embase,Central and SinoMed were retrieved with the retrieval time from their establishment to September 2017;in addition the related reference literatures were manually retrieved.The randomized controlled trials (RCTs) of PARP inhibitors for treating recurrent ovarian cancer were included.The meta analysis was performed by using the RevMan 5.3 software.Results A total of 5 RCTs were included,including 1 160 cases in the experimental group and 679 cases in the control group.When compared with placebo,PARP inhibitors significantly improved the progression-free survival HR=0.34,95％CI(0.30,0.40),P＜0.01] and overall survival HR=0.73,95％CI(0.55,0.96),P=0.025],and increased objective response rate RR=2.56,95％CI(1.17,5.59),P=0.020].The addition of PARP inhibitors to chemotherapy reduced the risk of disease progression HR =0.51,95 ％CI (0.34,0.77),P =0.001].However,there were no statistically significant differences in overall survival HR=1.17,95％CI(0.79,1.73),P=0.440] and objective response rate RR=1.11,95％CI(0.86,1.42),P =0.420] between the PARP inhibitors plus chemotherapy group and the chemotherapy alone group.The administration of PARP inhibitors was associated with a significantly increased risk of serious anemia,fatigue,nausea and vomiting.Conclusion PARP inhibitors could improve the progression-free survival outcome in recurrent ovarian cancer.