本文關(guān)鍵詞：索拉菲尼與免疫治療在治療晚期腎癌的療效與安全性的META分析　出處：《蘭州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腎腫瘤 索拉菲尼 免疫治療 系統(tǒng)評(píng)價(jià) Meta分析 隨機(jī)對(duì)照試驗(yàn)

【摘要】：腎癌,又稱腎細(xì)胞癌(renal cell carcinoma, RCC),腎癌的發(fā)病率居泌尿外科腫瘤的第二位,僅次于膀胱癌。腎癌的早期臨床癥狀不明顯,部分患者發(fā)現(xiàn)時(shí)已屬晚期,失去了行腎癌根治術(shù)的時(shí)機(jī),故腎癌患者的5年總生存率僅為20-25%。目前,腎癌最主要的治療方法是外科手術(shù)根治,但對(duì)于晚期腎癌患者,手術(shù)并未明顯改善患者的預(yù)后及生存質(zhì)量,又因腎癌對(duì)放療及化療均不敏感,因此,以索拉菲尼為代表的分子靶向治療及各種聯(lián)合治療方案在對(duì)晚期腎癌的治療上有著重要的意義。目的：系統(tǒng)評(píng)價(jià)索拉菲尼與免疫治療比較或索拉菲尼聯(lián)合免疫治療與單用索拉菲尼比較治療晚期腎癌的療效和安全性。方法：計(jì)算機(jī)檢索The Cochrane Library、PubMed、Web of Science、CBM、 CNKI、VIP和WanFang Data,檢索時(shí)限截止至2014年2月,收集索拉菲尼與免疫治療比較及索拉菲尼聯(lián)合免疫治療與單獨(dú)使用索拉菲尼治療比較的臨床隨機(jī)對(duì)照試驗(yàn)(RCTs).由兩位研究人員嚴(yán)格按照納入與排除的標(biāo)準(zhǔn),獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取及質(zhì)量評(píng)價(jià)后,應(yīng)用RevMan5.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果：研究最終共納入8個(gè)研究,共674例患者。Meta分析結(jié)果顯示：1.與免疫治療相比,療效上除索拉菲尼在晚期腎癌患者的無(wú)進(jìn)展生存期上有更好的臨床效益[MD=1.46,95%CI (0.07,2.85), P=0.04]外,其余兩組在總有效率、控制率的差異上均無(wú)統(tǒng)計(jì)學(xué)意義[總有效率：OR=1.53,95%CI (0.93,2.51),P=0.09；控制率：OR=1.42,95%CI (0.41,4.91), P=0.58]。在兩種治療常見(jiàn)的不良反應(yīng)事件上(乏力,腹瀉,惡心嘔吐,手足皮膚反應(yīng)),索拉菲尼除惡心嘔吐的不良反應(yīng)發(fā)生率低于免疫治療外,在其余三項(xiàng)常見(jiàn)不良事件的發(fā)生率上,差異均無(wú)統(tǒng)計(jì)學(xué)意義。2.與單用索拉菲尼相比,索拉菲尼聯(lián)合免疫治療的在疾病的總有效率、控制率及不良反應(yīng)發(fā)生率上,差異均無(wú)統(tǒng)計(jì)學(xué)意義[總有效率：OR=1.40,95%CI(0.75,2.61),P=0.29；控制率：OR=1.70,95%CI (0.99,2.94), P=0.06;不良事件發(fā)生率：OR=1.12,95% CI(0.32,3.92),P=0.85]。結(jié)論：基于當(dāng)前的臨床證據(jù),與免疫治療相比,索拉菲尼可延長(zhǎng)晚期腎癌患者疾病的無(wú)進(jìn)展生存期；索拉菲尼聯(lián)合免疫治療并不能增強(qiáng)對(duì)晚期腎癌患者的療效。Effectiveness and safety of sorafenib and immunotherapy for Advanced Renal Cell Carcinoma:A
[Abstract]:Renal cell carcinoma (RCC) is also called renal cell carcinoma (RCC). The incidence of renal cell carcinoma (RCC) is the second most common in urological tumors. Second only to bladder cancer. The early clinical symptoms of renal cell carcinoma is not obvious, some patients were found to be late, lost the opportunity to perform radical nephrectomy, so the overall 5-year survival rate of patients with renal cell carcinoma is only 20-25. At present. The main treatment for renal cell carcinoma is radical surgery, but for advanced renal cell carcinoma, surgery has not significantly improved the prognosis and quality of life of patients, but also because renal cell carcinoma is not sensitive to radiotherapy and chemotherapy, so. Molecular targeted therapy and various combination therapy protocols, represented by Solafini, are of great significance in the treatment of advanced renal cell carcinoma. The efficacy and safety of Solafini in the treatment of advanced renal cell carcinoma were systematically evaluated by comparing the efficacy and safety of Solafini with immunotherapy or solafini combined immunotherapy with solafini alone. Methods: The Cochrane was searched by computer. Library. The search time of PubMedof Web of Science CBM, CNKI, VIP and WanFang data is up to February 2014. To collect the clinical randomized controlled trial (RCTs) of Solafini compared with immunotherapy and salafenil combined immunotherapy with solafenil alone. The inclusion and exclusion criteria were strictly followed by two researchers. After independent literature screening, data extraction and quality evaluation, RevMan5.0 software was used to carry out statistical analysis. Results: the study was included in 8 studies. A total of 674 patients. Meta-analysis showed that: 1.Compared with immunotherapy, the curative effect was better than solafenil in the progressive survival of patients with advanced renal cell carcinoma. [There was no significant difference in the total effective rate and control rate between the other two groups except MD1.46 / 95CI 0.07 / 2.85, P0.04. [The total effective rate was 1.53 / 95 / CI 0.93 / 2.51 / P0.09; The control rate was 1.42 ~ 95% CI 0.41 ~ 4.91, P _ (0.58). There were two common adverse events (fatigue, diarrhea, nausea and vomiting) in the treatment of two kinds of common adverse events (fatigue, diarrhea, nausea and vomiting). In addition to nausea and vomiting, the incidence of adverse reactions of solafini was lower than that of immunotherapy, and the incidence of the other three common adverse events was higher than that of immunotherapy. Compared with solafenil alone, the total effective rate, control rate and adverse reaction rate of combined immunotherapy with Solafini had no statistical significance. [The total effective rate is 1.4095 / 0.75 / 0.75 / 2.61 / 0.29; The control rate was 1.70 / 95, CI = 0.99 / 2.94, P = 0.06; The incidence of adverse events was 1.1295% CI 0.32 / 3.92P 0.85. Conclusion: based on the current clinical evidence, compared with immunotherapy. Solafinil can prolong the progression free survival of advanced renal cell carcinoma patients. Solafini combined immunotherapy does not enhance the efficacy of and safety of sorafenib and in patients with advanced renal cell carcinoma. Immunotherapy for Advanced Renal Cell Carcinoma:A
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R737.11

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