VEGFR抑制剂治疗转移性肾细胞癌致出血风险的Meta分析★

The bleeding risk of patients with metastatic renal cell carcinoma treated with VEGFR inhibitors: a meta-analysis★

摘要:

目的 系统评价血管内皮细胞生长因子受体（VEGFR）抑制剂治疗转移性肾细胞癌的出血风险。方法 检索国内外相关数据库，收集VEGFR抑制剂治疗转移性肾细胞癌的临床试验。采用国际通用的Cochrane协作网偏倚风险评估工具进行方法学质量评价，采用RevMan 5.3软件进行Meta分析，比较VEGFR抑制剂与安慰剂或其他抗肿瘤药物的出血发生率。结果 与安慰剂或干扰素相比，VEGFR抑制剂的出血发生率显著升高［14.6% （258/1 769） vs. 3.4% （52/1 545）， RR=5.19， 95% CI （3.79，7.12）， P<0.000 01］；与哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂相比，VEGFR抑制剂的出血发生率明显降低［17.0% （106/622） vs. 4.6% （29/635）， RR=0.23， 95% CI （0.15，0.36）， P<0.000 01］。结论 VEGFR抑制剂用于转移性肾细胞癌有导致出血相关不良事件发生的风险，但其出血风险低于mTOR抑制剂。对于有出血风险的转移性肾细胞癌患者，临床应谨慎使用VEGFR抑制剂。

Abstract:

Objective To systematically evaluate the bleeding risk of patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor receptor (VEGFR) inhibitors.Methods Collected from domestic and foreign databases the clinical trials of metastatic renal cell carcinoma treated with VEGFR inhibitor monotherapy.By using the internationally commonly-used Cochrane Collaboration's Risk Assessment Tool for methodological quality, and RevMan 5.3 for meta-analysis,the incidence of bleeding risk was compared between VEGFR inhibitors (observation group) and placebo or other anti-tumor agents (control group).Results The results showed that VEGFR inhibitors caused a significantly higher incidence of bleeding risk than placebo or interferon [14.6% (258/1 769) vs. 3.4% (52/1 545), RR=5.19, 95% CI (3.79,7.12), P<0.000 01]. Compared with mammalian target of rapamycin (mTOR) inhibitors, VEGFR inhibitors significantly reduced the risk of bleeding [17.0% (106/622) vs. (4.6% 29/635), RR=0.23, 95% CI (0.15,0.36), P<0.000 01].Conclusion VEGFR inhibitors for metastatic renal cell carcinoma had a risk of bleeding, but the risk of bleeding was lower than that of mTOR inhibitors. VEGFR inhibitors should be used with caution for patients with metastatic renal cell carcinoma at risk of bleeding.