本文關(guān)鍵詞： 乳腺癌 新輔助治療 曲妥珠單抗 拉帕替尼 Meta分析　出處：《新疆醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：應(yīng)用Meta分析的統(tǒng)計學(xué)方法比較在HER2陽性乳腺癌中,新輔助化療分別聯(lián)合曲妥珠單抗、拉帕替尼、曲妥珠單抗和拉帕替尼雙靶向藥物三種不同療法的有效性和安全性。方法：計算機(jī)檢索PubMed、MEDLINE、The Cochrane Library、Web of science、CNKI、萬方數(shù)據(jù)庫,同時手工檢索近5年重要國際腫瘤學(xué)會議記錄,嚴(yán)格按照納入與排除標(biāo)準(zhǔn),收集所有比較HER2陽性乳腺癌患者使用新輔助化療分別聯(lián)合曲妥珠單抗、拉帕替尼、曲妥珠單抗和拉帕替尼雙靶向藥物三種不同治療的有效性和安全性的前瞻性隨機(jī)對照研究,按Cochrane系統(tǒng)評價方法進(jìn)行質(zhì)量評價、資料提取,運(yùn)用RevMan5.0軟件進(jìn)行Meta分析。結(jié)果：最終納入7項前瞻性隨機(jī)對照研究,共2227例患者。Meta分析結(jié)果顯示,拉帕替尼組的pCR率明顯低于曲妥珠單抗組[RR=0.80,95%CI (0.70-0.92),P=0.002];而曲妥珠單抗和拉帕替尼兩藥聯(lián)合組分別較曲妥珠單抗組、拉帕替尼組相比,pCR率均更高[RR=1.36,95%CI (1.19-1.56), P0.00001和RR=1.64,95%CI (1.28-2.11), P=0.0001]。III-IV度不良反應(yīng)方面,拉帕替尼組腹瀉[RR=6.74,95%CI (4.20-10.82), P0.00001]、皮膚損害[RR=6.42,95%CI (3.20-12.88), P0.00001]及肝臟損害[RR=1.78,95%CI (1.05-3.02),P=0.03]的發(fā)生率明顯高于曲妥珠單抗組；兩藥聯(lián)合組較曲妥珠單抗組相比,除了腹瀉[RR=12.20,95%CI (6.36-23.41), P0.00001]和皮膚損害[RR=3.76,95%CI(1.81-7.83),P=0.0004]發(fā)生率更高以外,其他均未見明顯差別：但兩藥聯(lián)合組較拉帕替尼組相比,并未增加患者不良反應(yīng)發(fā)生率,相反,其在Ⅲ-Ⅳ度充血性心力衰竭方面反而明顯低于拉帕替組[RR=0.21, 95%CI(0.05-0.82), P=0.02]結(jié)論：在HER2陽性乳腺癌新輔助治療中,拉帕替尼的有效性和安全性均低于曲妥珠單抗；曲妥珠單抗、拉帕替尼聯(lián)合的雙靶向治療較單一靶向治療有效性更高,同時安全性也尚可。
[Abstract]:Objective: to compare the effects of neo-adjuvant chemotherapy combined with tratozumab and Rapatinib in HER2 positive breast cancer by Meta analysis. The efficacy and safety of three different therapies, Tratozumab and Rapatini, were studied. Methods: the Cochrane MEDLINE of the Cochrane Library of CNKI, the Wanfang database, and the records of the recent five important international oncology conferences were searched by computer. According to the inclusion and exclusion criteria, all patients with HER2 positive breast cancer received neoadjuvant chemotherapy combined with tratozumab and Rapatini respectively. A prospective randomized controlled study of the efficacy and safety of tratozumab and Rapatinib in the treatment of three different therapies was conducted. The quality was evaluated by Cochrane system and the data were extracted. Results: 7 prospective randomized controlled trials were conducted with RevMan5.0 software. Results: a total of 2227 patients were analyzed by Meta-analysis. The pCR rate of the labatinib group was significantly lower than that of the trapezumab group [RRX 0.8095 [CI 0.70-0.92P0. 002], while that of the tratozumab and lapatinib groups was higher than that of the trapezumab group [RR1.36-9595CI 1.19-1.56, P0.00001 and RR1.6495CI 1.28-2.1111, P0.0001]. The incidence of diarrhoea [RRN 6.74-95CI 4.20-10.82, P0.00001], skin damage [RRR6.4295 CI 3.20-12.88, P0.00001] and liver damage [RRR1.78-95CI 1.05-3.02P0.03] was significantly higher than that of trotozumab group; the incidence of diarrhea [RR12.20 ~ 95CI 6.36-23.41, P0.00001] and skin damage [RRRN 3.79695 CI 1.81-7.83P0. 0004] was significantly higher in the combined group than that in the trotozumab group, with the exception of diarrhea [RRR12.20 ~ 95CI 6.36-23.41, P0.00001] and skin damage [RRN 3.7695 CI 1.81-7.83P0. 0004]. There was no significant difference between the two groups. However, the incidence of adverse reactions was not increased in the combination group compared with that in the Rapatini group, but on the contrary, there was no significant difference between the two groups. It was significantly lower in 鈪，

本文編號：1551526