Zhu Chenjing, Liu Jiaming, Zhang Jing, Li Qingfang, Lian Qisi, Xu Jing, Ma Xuelei
Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Oncotarget. 2017 Mar 31;8(41):71117-71127. doi: 10.18632/oncotarget.16759. eCollection 2017 Sep 19.
We conducted a meta-analysis to assess the efficacy and safety of dose-dense chemotherapy in the treatment of patients with urothelial carcinoma. A systematic search was conducted in PubMed, Medline, Embase, Web of Science and Cochrane Collaboration's Central register of controlled trials (CENTRAL) for relevant articles. Data was obtained from 10 trials with a total of 1093 patients. The pooled pathologic complete response (pCR) was 27.8% in the ten studies with a full cohort of 684 patients who received dose-dense methotrexate, vinblastine, adriamycin and cisplatin (dd-MVAC). In the controlled trials, although the difference was not significant, the pCR rate in the dd-MVAC group has a trend of increase (odds ratio (OR) 1.52; 95% confidence interval (CI) 0.78-2.98, 0.22) compared with classic MVAC group. A significant improvement of overall survival (OS) (hazard ratio (HR) 0.77, 95% CI 0.61-0.97, = 0.03) was also observed. Hematologic toxicities were the most frequent grade ≥ 3 toxicities including neutropenia/febrile neutropenia (17.5%), anemia (9.4%) and thrombocytopenia (6.1%). Compared with the classic MVAC group, dd-MVAC was associated with significantly decreased risks of all-grade adverse events (AEs) such as anemia (OR 0.457, 95% CI 0.249-0.840, = 0.012), febrile neutropenia (OR 0.398 95% CI 0.233-0.681, = 0.001), and neutropenia (OR 0.373, 95% CI 0.201-0.691, = 0.002). In conclusion, dose-dense chemotherapy was effective and tolerable in patients with urothelial carcinoma, which could be considered as a reasonable therapeutic option.
我们进行了一项荟萃分析，以评估剂量密集化疗治疗尿路上皮癌患者的疗效和安全性。在PubMed、Medline、Embase、Web of Science和Cochrane协作网的对照试验中央注册库（CENTRAL）中进行了系统检索，以查找相关文章。从10项试验中获取数据，共纳入1093例患者。在10项研究中，共有684例接受剂量密集型甲氨蝶呤、长春花碱、阿霉素和顺铂（dd-MVAC）治疗的患者，汇总的病理完全缓解（pCR）率为27.8%。在对照试验中，尽管差异不显著，但与经典MVAC组相比，dd-MVAC组的pCR率有上升趋势（比值比（OR）1.52；95%置信区间（CI）0.78 - 2.98，P = 0.22）。总生存期（OS）也有显著改善（风险比（HR）0.77，95% CI 0.61 - 0.97，P = 0.03）。血液学毒性是最常见的≥3级毒性，包括中性粒细胞减少/发热性中性粒细胞减少（17.5%）、贫血（9.4%）和血小板减少（6.1%）。与经典MVAC组相比，dd-MVAC与所有级别的不良事件（AE）风险显著降低相关，如贫血（OR 0.457，95% CI 0.249 - 0.840，P = 0.012）发热性中性粒细胞减少（OR 0.398，95% CI 0.233 - 0.681，P = 0.001）和中性粒细胞减少（OR 0.373，95% CI 0.201 - 0.691，P = 0.002）。总之，剂量密集化疗对尿路上皮癌患者有效且耐受性良好，可被视为一种合理的治疗选择。
