Lin Shuai, Shen Jun, Zhao Wanjun, Wang Xiaofei, Wang Xiaoqing, Zhu Jingqiang
Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Thyroid Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Ann Transl Med. 2019 Dec;7(24):802. doi: 10.21037/atm.2019.12.58.
At present, most of the targeted therapies for thyroid carcinoma are in the clinical trial stage, and there is still no strong evidence to confirm their clinical effect. The aim of this meta-analysis was to evaluate the outcome of targeted therapies and provide quantitative evidence.
Ovid, PubMed, EMBAS, ClinicalTrails.gov, and Cochrane Library electronic databases were searched until September 1, 2019. Randomized controlled studies (RCTs) studies that compared the treatment of thyroid carcinoma with the targeted therapies of utility and complications were analyzed.
The study included 5 studies with a total of 1,615 patients, with 991 cases in the drug group and 624 cases in the placebo group. The meta-analysis indicated that compared with the placebo group, the progression-free survival (PFS) rate of the drug group was significantly improved. The PFS of the drug group was 10.8 to 30.5 months, compared with 4 to 19.3 months for the placebo group (6 months PFS: OR =3.23, 95% CI: 2.57 to 4.05, P<0.00001, 12 months PFS: OR =3.38, 95% CI: 2.58 to 4.42, P<0.00001, 18 months PFS: OR =2.48, 95% CI: 1.74 to 3.54, P<0.00001). Overall survival (OS) did not differ significantly in the study (6 months: OR =1.53, 95% CI: 1.00 to 2.35, P=0.05, 12 months: OR =1.26, 95% CI: 0.94 to 1.69, P=0.12, 18 months: OR =1.11, 95% CI: 0.87 to 1.42, P=0.39). The incidence of adverse reactions in the drug group was significantly higher than that in the placebo group (OR =4.76, 95% CI: 3.45 to 6.57, P<0.00001), and the subgroup of adverse reactions was still significantly higher than that in the placebo group.
This meta-analysis revealed that the targeted drugs can significantly prolong PFS in patients with thyroid carcinoma, but the targeted drugs did not prolong the OS. Although the incidence of adverse reactions was significantly higher than that of the placebo group, the patients were still tolerable in drug group.
目前，大多数甲状腺癌的靶向治疗正处于临床试验阶段，尚无有力证据证实其临床疗效。本荟萃分析的目的是评估靶向治疗的结果并提供定量证据。
检索了Ovid、PubMed、EMBASE、ClinicalTrails.gov和Cochrane图书馆电子数据库，检索截至2019年9月1日。分析了比较甲状腺癌治疗与实用和并发症靶向治疗的随机对照研究（RCT）。
该研究纳入5项研究，共1615例患者，药物组991例，安慰剂组624例。荟萃分析表明，与安慰剂组相比，药物组的无进展生存期（PFS）率显著提高。药物组的PFS为10.8至30.5个月，而安慰剂组为4至19.3个月（6个月PFS：OR = 3.23，95%CI：2.57至4.05，P < 0.00001；12个月PFS：OR = 3.38，95%CI：2.58至4.42，P < 0.00001；18个月PFS：OR = 2.48，95%CI：1.74至3.54，P < 0.00001）。总生存期（OS）在研究中无显著差异（6个月：OR = 1.53，95%CI：1.00至2.35，P = 0.05；12个月：OR = 1.26，95%CI：0.94至1.69，P = 0.12；18个月：OR = 1.11，95%CI：0.87至1.42，P = 0.39）。药物组不良反应的发生率显著高于安慰剂组（OR = 4.76，95%CI：3.45至6.57，P < 0.00001），不良反应亚组仍显著高于安慰剂组。
本荟萃分析显示，靶向药物可显著延长甲状腺癌患者的PFS，但不能延长OS。虽然不良反应的发生率显著高于安慰剂组，但药物组患者仍可耐受。
