| Object:The purpose of this study is to systematically evaluate the efficacy,the improvement of quality of life,the change of vascular endothelial growth factor(VEGF)level in malignant pleural effusion or peritoneal effusions(MPPE),and the safety of application of bevacizumab combined with chemotherapy by intracavitary administration in the treatment of MPPE.Method:Databases including The Cochrane Library,PubMed,EMBASE,Web of Science,CBM,CNKI,VIP and WanFang Data were searched by computer,and other searches such as manual retrieval were also supplemented.Authors collected all relevant randomized controlled trials(RCTs)published at home and abroad about bevacizumab combined with chemotherapy by intracavitary administration in the treatment of MPPE.According to the criteria of literature inclusion and exclusion,at least two researchers conducted literature screening,data extraction and quality evaluation independently,and used Review Manager 5.3.5 software for meta-analysis to calculate relative risk(RR),standardized mean difference(SMD)and 95% confidence interval(CI).The end points were complete response rate(CR),overall response rate(ORR),disease control rate(DCR),improvement rate of quality of life,total stability rate of quality of life,level change of VEGF in MPPE before and after treatment and safety index.Results:A total of 1650 MPPE patients were enrolled in 26 RCTs studies.The results of meta analysis showed that:(1)Short-term efficacy: CR of bevacizumab combined with chemotherapy in the intrapleural or intraperitoneal administration group(Trial Group)(RR = 1.93,95%)CI =(1.64,2.26),P < 0.00001],ORR[RR = 1.42,95% CI =(1.33,1.53),P < 0.00001],DCR [RR = 1.12,95% CI =(1.08,1.17),P < 0.00001] were better than those of the intrapleural or intraperitoneal chemotherapy group(control group),the difference was statistically significant(P < 0.05);(2)Quality of life: the improvement rate of quality of life in the experimental group [RR = 1.75,95% CI =(1.51,2 03),P < 0.00001,the total stability rate of quality of life [RR = 1.25,95% CI =(1.15,1.36),P < 0.00001] was better than that of the control group,and the difference was statistically significant(P < 0.05);(3)VEGF level of MPPE: the decline of VEGF level of MPPE in the experimental group [the first cycle SMD=-1.81,95%CI=(-2.54,-1.09),P<0.00001,the second cycle SMD=-1.48,95%CI=(-1.95,-1.02),P<0.00001,the third cycle SMD=-1.38,95%CI=(-1.85,-0.92),P<0.00001,the fourth cycle SMD=-2.52,95%CI=(-3.91,-1.13),P=0.0004]were better than that of the control group,and the difference was statistically significant(P < 0.05).(4)Safety evaluation: The incidence of hypertension in the experimental group was higher than that in the control group,and there were statistical significance [RR=2.86,95% CI=(1.52,5.40),P=0.001].but there were no significant differences(P > 0.05)between two groups in the incidence of hemorrhage,proteinuria,leucopenia,digestive tract reaction,fever,thrombocytopenia,hemoglobin reduction,liver or kidney dysfunction,pain,fatigue,bone marrow suppression,weight loss,abnormal electrocardiogram,and there were also no significant differences in the severity of leukopenia and gastrointestinal reaction(?grade III).Conclusion:Compared with intrapleural or intraperitoneal chemotherapy,bevacizumab combined with chemotherapy in the intrapleural or intraperitoneal administration can improve the complete remission rate,overall response rate,disease control rate,improvement rate of quality of life,and the total stability rate of quality of life in the treatment of MPPE,VEGF level is significantly reduced in MPPE,but the incidence of hypertension increased. |
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