本文選題：轉(zhuǎn)移性黑色素瘤 + 干擾素α��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景惡性黑色素瘤是一種來源自神經(jīng)嵴黑色素細(xì)胞的惡性腫瘤,其惡性程度非常高,臨床預(yù)后較差。對于轉(zhuǎn)移性黑色素瘤來說,其五年存活率可低至10%,目前尚無有效的治療手段,經(jīng)典的治療方法是細(xì)胞毒性化療,但其有效率較低,且伴有明顯毒副反應(yīng)。隨著免疫遺傳學(xué)的快速發(fā)展,轉(zhuǎn)移性黑色素瘤的全身治療方法也有了新的進(jìn)展,免疫治療已成為目前的研究熱點(diǎn)。有學(xué)者發(fā)現(xiàn)將免疫治療聯(lián)合化療藥物應(yīng)用(即生物化療)能夠提高療效。已有多項(xiàng)隨機(jī)對照試驗(yàn)探究免疫細(xì)胞因子干擾素α聯(lián)合化療與單純化療之間的差異,盡管結(jié)果不盡相同,但許多人認(rèn)為生物化療可以增加相關(guān)反應(yīng)率,同時(shí)也增加了毒副反應(yīng)。為了獲得一個(gè)不偏不倚和可靠的真實(shí)效益評估,本文對干擾素α聯(lián)合化療治療轉(zhuǎn)移性黑色素瘤的相關(guān)隨機(jī)試驗(yàn)進(jìn)行了薈萃分析。目的通過與單純化療相對比,對干擾素α聯(lián)合化療治療轉(zhuǎn)移性黑色素瘤的臨床療效和安全性進(jìn)行系統(tǒng)評價(jià)。方法計(jì)算機(jī)系統(tǒng)檢索PubMed,MEDLINE,EMBASE,The Cochrane Library,中國知網(wǎng)、維普中文科技期刊、萬方數(shù)據(jù)庫自建庫起截止到2016年9月的相關(guān)文獻(xiàn),根據(jù)制定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)進(jìn)行篩選,并對最終納入的文獻(xiàn)結(jié)果應(yīng)用RevMan 5.3進(jìn)行Meta分析,使用相對危險(xiǎn)度(RR)和95%置信區(qū)間(95%CI)來計(jì)算有效率、總體生存率和毒副反應(yīng)。結(jié)果一共納入了14篇隨機(jī)對照研究,共涉及1708例轉(zhuǎn)移性黑色素瘤患者,其中IFN-α聯(lián)合化療組897例,單純化療組811例。與單純化療相比,IFN-α聯(lián)合化療可以提高轉(zhuǎn)移性黑色素瘤患者的完全緩解率(RR=2.97,95%CI=1.89-4.67,P0.00001)、部分緩解率(RR=1.31,95%CI=1.05-1.64,P=0.02)和總有效率(RR=1.59,95%CI=1.32-1.92,P0.00001);而兩組的1年總體生存率(RR=1.08,95%CI=0.90-1.30,P=0.39)、3年總體生存率(RR=1.44,95%CI=0.82-2.54,P=0.20)均無統(tǒng)計(jì)學(xué)差異;IFN-α聯(lián)合化療的血液系統(tǒng)反應(yīng)(RR=1.44,95%CI=0.63-3.28,P=0.38)、惡心和嘔吐反應(yīng)(RR=1.03,95%CI=0.78-1.35,P=0.86)無顯著增加,而藥物性發(fā)熱反應(yīng)(RR=4.06,95%CI 1.67-9.87,P=0.002)的發(fā)生率明顯增加。結(jié)論1.與單純化療相比,IFN-α聯(lián)合化療可以提高轉(zhuǎn)移性黑色素瘤患者的完全緩解率、部分緩解率和總有效率,但不能改善患者的1年、3年總體生存率。2.與單純化療相比,IFN-α聯(lián)合化療沒有增加轉(zhuǎn)移性黑色素瘤患者的血液系統(tǒng)毒副反應(yīng)、惡心和嘔吐反應(yīng),但藥物性發(fā)熱的發(fā)生率明顯增高。
[Abstract]:Background malignant melanoma is a malignant tumor derived from neural crest melanocytes. Its malignant degree is very high and its clinical prognosis is poor. For metastatic melanoma, the 5-year survival rate can be as low as 10 years, and there is no effective treatment. The classical treatment is cytotoxic chemotherapy, but its effective rate is low, and it has obvious side effects. With the rapid development of immunogenetics, systemic treatment of metastatic melanoma has made new progress, immunotherapy has become a hot topic. Some researchers have found that immunotherapy combined with chemotherapeutic drugs (i.e. biochemotherapy) can improve the efficacy. A number of randomized controlled trials have been conducted to explore the difference between immunocyte factor interferon 偽 combination chemotherapy and chemotherapy alone. Although the results are not the same, many people think that biochemotherapy can increase the response rate, but also increase the toxic side effects. In order to obtain an impartial and reliable evaluation of the true benefit, a meta-analysis of the randomized trials of interferon 偽 combined chemotherapy in the treatment of metastatic melanoma was carried out. Objective to evaluate the efficacy and safety of interferon-偽 combined chemotherapy in the treatment of metastatic melanoma. Methods A computer system was used to search the relevant documents of PubMedus MEDLINE EMBASEN the Cochrane Library, Chinese Journal of Science and Technology of Weipu, and Wanfang database, and to screen them according to the inclusion criteria and exclusion criteria. Meta-analysis was performed with RevMan 5.3 and the relative risk (RR) and 95% confidence interval (95% CI) were used to calculate the effective rate, overall survival rate and toxicity. Results A total of 14 randomized controlled studies were conducted, involving 1708 patients with metastatic melanoma, including 897 cases in IFN- 偽 combined chemotherapy group and 811 cases in simple chemotherapy group. Compared with chemotherapy alone, combination chemotherapy with IFN- 偽 can improve the complete remission rate of metastatic melanoma patients and the overall 1 year overall survival rate of the two groups is not significantly different from that of the patients with metastatic melanoma. The overall 1 year overall survival rate is 0.90-1.30P0.39, and the overall 3-year survival rate is higher than that of the RRR1.3195CII 1.05-1.64P0.02) and the total effective rate RR1.5995CII 1.32-1.92P0.00001. There is no statistical difference between the two groups in the 1-year overall survival rate of RR1.08-95CI0.9CI0.90-1.30P0.39, and the 3-year overall survival rate of RR1.449595 ~ 0.82-2.54P0.20. There is no statistical difference between the two groups in the overall survival rate of RR1.08-95CII (0.90-1.30P0.39) and the overall 3-year survival rate of RRN- 偽 (1.39595 CI 1.05-1.64P0.02). The blood system response of IFN- 偽 in combination chemotherapy was not significantly increased, but no significant increase was found in the blood system reaction of RRN- 偽 combined chemotherapy and CI0.63-3.28 P0. 38%, and the nausea and vomiting response of RRN 1.0395% CI0.78-1.35 P0. 86). However, the incidence of drug induced fever was significantly increased in RRX 4.0695 CI 1.67-9.87 P0. 002. Conclusion 1. Compared with chemotherapy alone, combination chemotherapy with IFN- 偽 can improve the complete remission rate, partial remission rate and total effective rate of metastatic melanoma patients, but it can not improve the overall survival rate of 1 year and 3 years in patients with metastatic melanoma. Compared with chemotherapy alone, combination chemotherapy with IFN- 偽 did not increase the toxic side effects, nausea and vomiting in the blood system of patients with metastatic melanoma, but the incidence of drug-induced fever was significantly higher.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.5

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