低分子量肝素与癌症生存率：文献综述及1726例接受至少三个月治疗患者的汇总分析

Low-molecular-weight heparin and cancer survival: review of the literature and pooled analysis of 1,726 patients treated for at least three months.

作者信息

Conti Serenella, Guercini Francesco, Iorio Alfonso

机构信息

Sezione di Medicina Interna e Cardiovascolare, Università di Perugia, Perugia, Italy.

出版信息

Pathophysiol Haemost Thromb. 2003;33(4):197-201. doi: 10.1159/000081508.

DOI:10.1159/000081508

PMID:15583449

Abstract

BACKGROUND

Heparin has been the main subject of intensive investigation and clinical use because of its therapeutic anticoagulant properties. It also exhibits many other biological activities, and it was claimed that it shows a beneficial effect on cancer spreading. Searching for papers investigating the effect of low-molecular-weight heparin (LMWH) on cancer mortality we found clinical trials and meta-analyses which showed a reduction in the mortality rate in cancer patients. However, the biological rationale of this effect for a short treatment with LMWH remains unclear. We wanted to check if similar results were achieved in cancer patients treated with LMWH for a longer period of time.

AIM

To evaluate the effect on cancer mortality of a 3-month treatment with LMWH by performing a meta-analysis of published studies comparing LMWH and oral anticoagulants (OA) in the prevention of recurrent venous thromboembolism (VTE).

MATERIALS AND METHODS

Computerized searches of Medline and Embase were performed; clinical trials were also located through colleagues and hand scanning of meeting proceedings. Eligibility of the studies and extraction of data were performed by two authors using a standard form. The meta-analysis was performed assuming a fixed-effect model.

RESULTS

Eight studies were identified that fulfilled our predefined criteria for a total of 1,726 patients. After a mean of 8.6 months of follow-up, 327 patients had died of cancer, 160 in the LMWH group and 167 in the OA control group (OR 0.95, 95% CI 0.73-1.23; z = 0.42; p = 0.67). Considering cancer mortality in 948 cancer patients the figures were 160/472 in the LMWH group and 167/476 in the OA control group (OR 0.96, 95% CI 0.73-1.25; z = 0.33; p = 0.74).

CONCLUSIONS

In 1,726 patients randomized to receive a long-term course of at least 3 months of LMWH or OA for the treatment of VTE, no effect on cancer mortality was found.

摘要

背景

肝素因其治疗性抗凝特性一直是深入研究和临床应用的主要对象。它还具有许多其他生物学活性，并且有人声称它对癌症扩散有有益作用。在搜索研究低分子量肝素（LMWH）对癌症死亡率影响的论文时，我们发现临床试验和荟萃分析表明癌症患者的死亡率有所降低。然而，LMWH短期治疗产生这种效果的生物学原理仍不清楚。我们想检查长期接受LMWH治疗的癌症患者是否也能取得类似结果。

目的

通过对已发表的比较LMWH和口服抗凝剂（OA）预防复发性静脉血栓栓塞（VTE）的研究进行荟萃分析，评估LMWH 3个月治疗对癌症死亡率的影响。

材料与方法

对Medline和Embase进行计算机检索；还通过同事以及对会议记录的手工查阅来查找临床试验。由两位作者使用标准表格进行研究的合格性评估和数据提取。采用固定效应模型进行荟萃分析。

结果

确定了8项符合我们预定义标准的研究，共1726例患者。平均随访8.6个月后，327例患者死于癌症，LMWH组160例，OA对照组167例（比值比0.95，95%可信区间0.73 - 1.23；z = 0.42；p = 0.67）。在948例癌症患者中考虑癌症死亡率，LMWH组为160/472，OA对照组为167/476（比值比0.96，95%可信区间0.73 - 1.25；z = 0.33；p = 0.74）。