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目的评价卡培他滨联合伊立替康(CAPIRI)方案与氟尿嘧啶联合伊立替康(FOLFIRI)方案对照治疗晚期结直肠癌的疗效与安全性。方法运用计算机在Pub Med、Embase数据库、万方数据库、中国知网、Cochran图书馆上进行检索。检索时间均从2000年1月-2015年10月,对符合纳入标准的随机对照试验进行质量评价、数据提取并应用Rev Man 5.2进行Meta分析。结果纳入8个随机对照试验,共计1 634例患者,CAPIRI在完全缓解率[RR=1.17,95%CI(0.70,1.96),P=0.56]、总有效率[RR=0.90,95%CI(0.79,1.03),P=0.12]、疾病控制率[RR=0.93,95%CI(0.87,1.00),P=0.06]、中位无疾病进展期[HR=1.00,95%CI(0.72,1.37),P=0.99]、中位总生存期[HR=0.94,95%CI(0.63,1.40),P=0.77]方面表现出与FOLFIRI相似的效果。安全性方面,CAPIRI有较高的Ⅲ/Ⅳ级呕吐[RR=1.91,95%CI(1.13,3.22),P=0.02]、腹泻[RR=2.84,95%CI(2.22,3.63),P<0.000 01]、手足综合征[RR=4.55,95%CI(2.15,9.61),P<0.000 1]发生风险;而恶心[RR=0.77,95%CI(0.64,0.93),P=0.005]、疲劳[RR=1.19,95%CI(0.73,1.94),P=0.47]、发热性中性粒细胞减少[RR=1.59,95%CI(0.89,2.87),P=0.12]、贫血[RR=1.74,95%CI(0.59,5.18),P=0.32]、白细胞减少[RR=1.23,95%CI(0.86,1.77),P=0.25]、嗜中性粒细胞减少症[RR=0.77,95%CI(0.64,0.93),P=0.005]两组方案则相似。结论 CAPIRI治疗晚期结直肠癌是有效的,毒性反应是可以接受及处理的。
Objective To evaluate the efficacy and safety of capecitabine combined with irinotecan (CAPIRI) regimen and fluorouracil combined with irinotecan (FOLFIRI) regimen in the treatment of advanced colorectal cancer. Methods The computer was used to search PubMed, Embase database, Wanfang database, CNKI, Cochran library. The retrieval time was from January 2000 to October 2015, and the quality of the randomized controlled trials which met the inclusion criteria was evaluated. The data were extracted and Meta-analysis was performed using Rev Man 5.2. Results A total of 1 634 patients were enrolled in 8 RCTs with complete response rate [RR = 1.17, 95% CI (0.70, 1.96), P = 0.56], total effective rate [RR = 0.90, 95% CI (RR = 0.93, 95% CI 0.87, 1.00, P = 0.06), median disease-free progression [HR = 1.00, 95% CI ), P = 0.99], and median overall survival [HR = 0.94, 95% CI (0.63, 1.40), P = 0.77] showed similar effects as FOLFIRI. In terms of safety, CAPIRI had higher grade III / IV vomiting [RR = 1.91, 95% CI 1.13, 3.22, P = 0.02], diarrhea [RR = 2.84, 95% CI 2.22, 3.63, P < 0.000 01], risk of hand-foot syndrome [RR = 4.55,95% CI (2.15,9.61), P <0.0001]; and nausea [RR = 0.77,95% CI (0.64,0.93), P = 0.005] Fatigue [RR = 1.19, 95% CI (0.73, 1.94), P = 0.47], febrile neutropenia [RR = 1.59,95% CI (0.89,2.87, P = 0.12] 1.74,95% CI 0.59,5.18 P = 0.32], leukopenia (RR = 1.23, 95% CI 0.86, 1.77, P 0.25), neutropenia [RR 0.77, 95 % CI (0.64, 0.93), P = 0.005] The two regimens were similar. Conclusions CAPIRI is effective in the treatment of advanced colorectal cancer and its toxicity is acceptable and manageable.