Zhao ChuanJie, Li ShuLiang, Liu Qiang
a Department of Gastrointestinal Surgery , The Second People's Hospital of LiaoCheng , Shandong Province , China.
b Department of Surgical Oncology Surgery , The First Hospital of HeBei Medical University , ShiJiaZhuang , China.
J Chemother. 2016 Aug;28(4):321-7. doi: 10.1179/1973947815Y.0000000049.
Patients aged 65 years and older are often under-represented in clinical trials of metastatic colorectal cancer (mCRC) and probably undertreated in clinical practice. We performed a meta-analysis of randomized controlled trials to assess the efficacy of molecular targetted agents (MTAs) in this population.
A comprehensive literature search for studies published up to December 2014 was performed. The endpoints were overall survival (OS) and progression-free survival (PFS). The pooled hazard ratio (HR) and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials.
Eleven randomized controlled trials involved 8,488 patients were ultimately identified. The pooled analysis demonstrated that the use of MTAs in elderly patients with mCRC significantly improved OS (HR 0.84, 95% CI: 0.76-0.92, p < 0.001) and PFS (HR 0.78, 95% CI: 0.64-0.96, p = 0.017) when compared to MTAs-free therapies. Similar results of OS were observed in sub-group analysis according to treatment line and regimes. No publication bias was detected by Begg's and Egger's tests.
The introduction of MTAs to therapies offers a survival benefit in elderly patients with mCRC. Further studies aimed at this specific patient population are still needed to monitor potential treatment-related toxicities to optimize the use of these drugs.
65岁及以上的患者在转移性结直肠癌（mCRC）临床试验中的代表性往往不足，在临床实践中可能也未得到充分治疗。我们进行了一项随机对照试验的荟萃分析，以评估分子靶向药物（MTA）在该人群中的疗效。
对截至2014年12月发表的研究进行了全面的文献检索。终点指标为总生存期（OS）和无进展生存期（PFS）。根据纳入试验的异质性，采用固定效应或随机效应模型计算合并风险比（HR）和95%置信区间（CI）。
最终确定了11项涉及8488例患者的随机对照试验。汇总分析表明，与不使用MTA的治疗相比，在老年mCRC患者中使用MTA可显著改善OS（HR 0.84，95%CI：0.76 - 0.92，p < 0.001）和PFS（HR 0.78，95%CI：0.64 - 0.96，p = 0.017）。根据治疗线和方案进行的亚组分析中观察到了类似的OS结果。Begg检验和Egger检验未检测到发表偏倚。
在治疗中引入MTA可使老年mCRC患者获得生存益处。仍需要针对这一特定患者群体进行进一步研究，以监测潜在的治疗相关毒性，从而优化这些药物的使用。
