發(fā)布時間：2018-05-24 03:58

  本文選題：膠質(zhì)瘤 + 替莫唑胺　； 參考：《蘭州大學(xué)》2014年碩士論文

【摘要】：目的腦膠質(zhì)瘤是最常見的顱內(nèi)原發(fā)性腫瘤,大多為浸潤性生長。根據(jù)2011年美國腦腫瘤登記報告,大約40%的中樞神經(jīng)系統(tǒng)腫瘤為高級別惡性腫瘤。目前國內(nèi)外治療腦膠質(zhì)瘤的原則主要是以手術(shù)為基礎(chǔ)聯(lián)合放化療的綜合治療。當前化療藥物眾多,目前還沒有標準的化療方案。本研究在對替莫唑胺(Temozolomide, TMZ)與傳統(tǒng)化療藥治療高級別腦膠質(zhì)瘤的有效性和安全性進行系統(tǒng)評價的基礎(chǔ)上,利用歷史性隊列研究方法收集TMZ方案(TMZ同步放化療加后續(xù)TMZ輔助化療)和傳統(tǒng)化療藥替尼泊苷(Teniposide,VM-26)聯(lián)合順鉑(Cisplatin,DDP)方案(VP方案)治療高級別腦膠質(zhì)瘤的臨床資料,分析比較兩組藥物臨床療效,從而為臨床決策提供證據(jù)參考。 方法①計算機檢索PubMed、EMBASE、Cochrane Library、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫、中文科技期刊全文數(shù)據(jù)庫、相關(guān)期刊論文、中華醫(yī)學(xué)會數(shù)字化期刊,納入TMZ對比傳統(tǒng)化療藥治療腦膠質(zhì)瘤的隨機對照試驗(Randomized Controlled Trial,RCT),檢索時間截至2013年12月。采用質(zhì)量評價工具評價納入研究質(zhì)量；②采用歷史性隊列研究方法,客觀評價TMZ方案和VP方案治療腦膠質(zhì)瘤的臨床療效及經(jīng)濟學(xué)指標。使用SPSS19.0軟件進行統(tǒng)計分析。 結(jié)果①研究納入8個RCTs,864例患者,其中TMZ組374例,傳統(tǒng)化療藥物組490例。Meta分析結(jié)果顯示,在治療有效率[RR=1.48,95%CI(1.24,1.77)]、5年生存率[HR=23.94,95%CI(13.26,43.22)]、無進展生存期[MD=4.00,95%CI(2.61,5.39)]、平均生存期[SMD=1.84,95%CI(1.40,2.27)]、消化道反應(yīng)[RR=0.53,95%CI(0.39,0.71)]和骨髓抑制[RR=0.20,95%CI(0.08,0.51)]等方面兩組差異均有統(tǒng)計學(xué)意義,TMZ組優(yōu)于傳統(tǒng)化療藥組；②歷史性隊列研究共納入患者31例,TMZ組16例,VP組15例,研究結(jié)果提示：TMZ組與VP組的近期療效無明顯統(tǒng)計學(xué)差異,而TMZ組在單次平均總住院費用及單次化療平均住院費用上高于VP組,Cox回歸分析提示年齡與病理分級是腦膠質(zhì)瘤患者預(yù)后的獨立影響因素。 結(jié)論①系統(tǒng)評價研究顯示,兩組化療方案在治療高級別腦膠質(zhì)瘤的比較上,TMZ組化療效果優(yōu)于傳統(tǒng)化療藥組；②歷史性隊列研究提示TMZ組與VP組對于高級別腦膠質(zhì)瘤的治療效果相當,但TMZ組經(jīng)濟學(xué)負擔更重。由于回顧性研究的自身局限性,結(jié)論有待于大樣本、隨訪時間長的研究來進一步驗證。
[Abstract]:Objective glioma is the most common primary intracranial tumor, mostly invasive growth. According to the 2011 U.S. brain Cancer Registry, about 40 percent of central nervous system tumors are high-grade malignancies. At present, the principle of glioma treatment at home and abroad is based on surgery combined with radiotherapy and chemotherapy. There are many chemotherapeutic drugs and there is no standard chemotherapy regimen. This study was based on a systematic evaluation of the efficacy and safety of temozolomide (TMZ) and traditional chemotherapeutic agents in the treatment of high-grade gliomas. A historical cohort study was used to collect the clinical data of TMZ regimen combined with TMZ adjuvant chemotherapy and teniposide Teniposidede VM-26 (combined with cisplatin Cisplatinine) regimen (VP regimen) in the treatment of high grade gliomas. To analyze and compare the clinical efficacy of the two groups of drugs, so as to provide evidence for clinical decision-making. Methods 1 A computer-based search was conducted for PubMedus EMBASE Cochrane Library, Chinese Biomedical Literature Database, Chinese Sci-tech Journal Full-text Database, Chinese Journal Full-text Database and Chinese Medical Association Digital Journal. A randomized controlled trial of TMZ was used to treat gliomas compared with traditional chemotherapeutic agents. The search time was up to December 2013. To evaluate the clinical efficacy and economic indexes of TMZ regimen and VP regimen in the treatment of glioma. Use SPSS19.0 software for statistical analysis. Results 1 the study included 864 patients with RCTsN, including 374 patients in TMZ group and 490 patients in traditional chemotherapeutic drugs group. There were significant differences between the two groups in the effective rate [RRN 1.4895 CII 1.241.77], 5-year survival rate (HR23.9495 CI 13.262643.22), progression-free survival (MD4.00 / 95CI2.61 / 5.39), mean survival [SMD1.895CI1.402.27], digestive tract reaction (RRN0.5395CI0.39 / 0.71) and bone marrow suppression (RRR0.2095CI0.080.51). 2 the historical cohort study included 31 patients with TMZ and 16 patients with VP. The results showed that there was no significant difference in the short-term curative effect between the two groups. However, the average total hospitalization cost and average hospitalization cost of single chemotherapy in TMZ group were higher than those in VP group, which indicated that age and pathological grade were independent factors for prognosis of glioma patients. Conclusion (1) systematic evaluation study showed that the chemotherapy effect of TMZ group was better than that of traditional chemotherapy group in the treatment of high-grade glioma. 2 the historical cohort study showed that TMZ group and VP group had the same therapeutic effect for high grade glioma, but the TMZ group had more economic burden. Due to the limitations of the retrospective study, the conclusions need to be further verified by a large sample and a long follow-up study.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41

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