紫杉醇治療上皮性卵巢癌密集型療法的系統評價_《中國循證醫學雜志》

作者：

1. 四川大學華西第二醫院婦產科（成都 610041）； 2. 四川大學華西醫院循證醫學與臨床流行病學教研室（成都 610041）;

關鍵詞：

紫杉醇密集型療法傳統療法卵巢癌系統評價

DOI：

10.7507/1672-2531.20090241

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目的　系統評價紫杉醇聯合鉑類治療上皮性卵巢癌密集型療法的臨床療效和安全性。
方法　計算機檢索Cochrane 臨床對照試驗資料庫（2008 年第2 期）、MEDLINE（1980 年1 月～ 2008 年6 月）、EMbase（1984 ～ 2008年6 月）、中國生物醫學文獻數據庫（1980 年1 月～ 2008 年6 月）、CNKI（1980 ～ 2008 年6 月）等，收集有關紫杉醇治療上皮性卵巢癌密集型療法與傳統療法的隨機對照試驗（RCT）。由兩名研究者共同完成文獻篩選、資料提取并進行質量評價后，采用RevMan 5.0 軟件進行Meta 分析。
結果　最終納入6 篇文獻，其中外文3 篇、中文3 篇，包括572 例患者。Meta 分析結果顯示：① 療效評估：密集型療法與傳統療法在治療有效率［RR=1.06，95%CI（0.94，1.20）］、中位生存期、生存率、中位無進展生存時間、中位進展時間方面差異均無統計學意義。② 毒副反應：密集型療法在降低Ⅲ度以上中性粒細胞減少的發生率［RR=0.49，95%CI（0.35，0.69），P lt;0.000 1］以及Ⅲ度以上神經毒性反應［RR=0.43，95%CI（0.24，0.78），P=0.006］上有明顯優勢。面色潮紅、Ⅲ度以上的嘔吐、貧血、白細胞減少、Ⅲ度以上血小板減少以及脫發等方面與傳統療法相比，其差異無統計學意義。
結論　紫杉醇密集型療法和傳統療法比較，治療效果相似，毒副反應基本相近，但能明顯降低Ⅲ度以上中性粒細胞減少及Ⅲ度以上神經毒性反應的發生率。因此，密集型療法是傳統療法良好的替代治療方案。

引用本文： 程萌,謝聰,王丹青,尹如鐵,康德英. 紫杉醇治療上皮性卵巢癌密集型療法的系統評價. 中國循證醫學雜志, 2009, 09(12): 1328-1335. doi: 10.7507/1672-2531.20090241 復制

1.	Wang TH, Wang HS, Soong YK. Paclitaxel-induced cell death: where the cell cycle and apoptosis come together. Cancer, 2000, 88(11): 2619-2628.
2.	Kuh HJ, Jang SH, Wientjes MG, et al. Computational model of intracellular pharmacokinetics of paclitaxel. J Pharmacol Exp Ther, 2000, 293(3): 761-770.
3.	陸紅霞. 紫杉醇劑型、臨床用藥方式及聯合用藥的研究進展. 國外醫學藥學分冊, 2005, 2(32): 73-77。.
4.	Mori T, Kinoshita Y, Watanabe A, et al. Retention of paclitaxel in cancer cells for 1 week in vivo and in vitro. Cancer Chemother Pharmacol, 2006, 58(5): 665-672.
5.	Choy H, Akerley W, Safran H, et al. Phase I trial of outpatient weekly paclitaxel and concurrent radiation therapy for advanced non-smallcell lung cancer. J Clin Oncol, 1994, 12(12): 2682-2686.
6.	Sehouli J, Stengel D, Mustea A, et al. Weekly paclitaxel and carboplatin (PC-W) for patients with primary advanced ovarian cancer: results of a multicenter phase-II study of the NOGGO. Cancer Chemother Pharmacol, 2008, 61(2): 243-250.
7.	Higgins JLT, Green S. The Cochrane collaboration. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. The Cochrane Library, 2006.
8.	Rosenberg P, Andersson H, Boman K, et al. Randomized trial of single agent paclitaxel given weekly versus every three weeks and with peroral versus intravenous steroid premedication to patients with ovarian cancer previously treated with platinum. Acta Oncol, 2002, 41(5): 418- 424.
9.	Wu CH, Yang CH, Lee JN, et al. Weekly and monthly regimens of paclitaxel and carboplatin in the management of advanced ovarian cancer. A preliminary report on side effects. Int J Gynecol Cancer, 2001, 11(4): 295-299.
10.	de Jongh FE, de Wit R, Verweij J, et al. Dose-dense cisplatin/paclitaxel. a well-tolerated and highly effective chemotherapeutic regimen in patients with advanced ovarian cancer. Eur J Cancer, 2002, 38(15): 2005-2013.
11.	段微, 路虹, 范逢曉. 國產紫杉醇治療上皮性卵巢癌周療方案與月療方案的比較. 中國腫瘤臨床與康復, 2006, 13(1): 73-74.
12.	朱麗榮, 廖秦平, 溫宏武, 等. 紫杉醇治療卵巢癌周療與月療的臨床對比研究. 中國醫刊, 2004, 39(4): 32-37.
13.	沈鏗, 李孟達, 豐有吉, 等. 代表中國婦科腫瘤學組. 泰素周療和三周療法作為卵巢癌一線化療的多中心對照研究. 中華醫學雜志, 2005, 8(30): 2099-2103.
14.	Gianni L, Keens CM, Gianni A, et al. Non-linear pharmacokinetics and metabolism of paclitaxel and its pharmacokinetic/ pharmacodynamic relationships in humans. J Clin Oncol, 1995, 13: 180-190.
15.	Kurihara M, Sakamoto H, Ohta Y, et al. Patient compliance and the quality of life are well maintained in weekly paclitaxel and carboplatin therapy for advanced gynecologic cancers in Japanese women. Gan To Kagaku Ryoho, 2001, 28: 55-61.

1. Wang TH, Wang HS, Soong YK. Paclitaxel-induced cell death: where the cell cycle and apoptosis come together. Cancer, 2000, 88(11): 2619-2628.
2. Kuh HJ, Jang SH, Wientjes MG, et al. Computational model of intracellular pharmacokinetics of paclitaxel. J Pharmacol Exp Ther, 2000, 293(3): 761-770.
3. 陸紅霞. 紫杉醇劑型、臨床用藥方式及聯合用藥的研究進展. 國外醫學藥學分冊, 2005, 2(32): 73-77。.
4. Mori T, Kinoshita Y, Watanabe A, et al. Retention of paclitaxel in cancer cells for 1 week in vivo and in vitro. Cancer Chemother Pharmacol, 2006, 58(5): 665-672.
5. Choy H, Akerley W, Safran H, et al. Phase I trial of outpatient weekly paclitaxel and concurrent radiation therapy for advanced non-smallcell lung cancer. J Clin Oncol, 1994, 12(12): 2682-2686.
6. Sehouli J, Stengel D, Mustea A, et al. Weekly paclitaxel and carboplatin (PC-W) for patients with primary advanced ovarian cancer: results of a multicenter phase-II study of the NOGGO. Cancer Chemother Pharmacol, 2008, 61(2): 243-250.
7. Higgins JLT, Green S. The Cochrane collaboration. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. The Cochrane Library, 2006.
8. Rosenberg P, Andersson H, Boman K, et al. Randomized trial of single agent paclitaxel given weekly versus every three weeks and with peroral versus intravenous steroid premedication to patients with ovarian cancer previously treated with platinum. Acta Oncol, 2002, 41(5): 418- 424.
9. Wu CH, Yang CH, Lee JN, et al. Weekly and monthly regimens of paclitaxel and carboplatin in the management of advanced ovarian cancer. A preliminary report on side effects. Int J Gynecol Cancer, 2001, 11(4): 295-299.
10. de Jongh FE, de Wit R, Verweij J, et al. Dose-dense cisplatin/paclitaxel. a well-tolerated and highly effective chemotherapeutic regimen in patients with advanced ovarian cancer. Eur J Cancer, 2002, 38(15): 2005-2013.
11. 段微, 路虹, 范逢曉. 國產紫杉醇治療上皮性卵巢癌周療方案與月療方案的比較. 中國腫瘤臨床與康復, 2006, 13(1): 73-74.
12. 朱麗榮, 廖秦平, 溫宏武, 等. 紫杉醇治療卵巢癌周療與月療的臨床對比研究. 中國醫刊, 2004, 39(4): 32-37.
13. 沈鏗, 李孟達, 豐有吉, 等. 代表中國婦科腫瘤學組. 泰素周療和三周療法作為卵巢癌一線化療的多中心對照研究. 中華醫學雜志, 2005, 8(30): 2099-2103.
14. Gianni L, Keens CM, Gianni A, et al. Non-linear pharmacokinetics and metabolism of paclitaxel and its pharmacokinetic/ pharmacodynamic relationships in humans. J Clin Oncol, 1995, 13: 180-190.
15. Kurihara M, Sakamoto H, Ohta Y, et al. Patient compliance and the quality of life are well maintained in weekly paclitaxel and carboplatin therapy for advanced gynecologic cancers in Japanese women. Gan To Kagaku Ryoho, 2001, 28: 55-61.

《中國循證醫學雜志》

紫杉醇治療上皮性卵巢癌密集型療法的系統評價

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《中國循證醫學雜志》

紫杉醇治療上皮性卵巢癌密集型療法的系統評價

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