Riziko venózneho tromboembolizmu u pacientov liečených cisplatinou: systematický prehľad a metaanalýza

SOUHRN

Cieľ

Na základe výsledkov niekoľkých publikácií existuje predpoklad o spojitosti medzi cisplatinou a zvýšeným rizikom tromboembolizmu. Avšak keďže zvýšené riziko venóznych tromboembolických príhod (VTE) spojených s chemoterapiou založenou na cisplatine nie je doposiaľ dostatočne preskúmané, uskutočnili sme systematický prehľad a metaanalýzu randomizovaných klinických štúdií zisťujúcich incidenciu a riziko VTE asociovaných s chemoterapiou založenou na cisplatine.

Metódy

V databáze PubMed sme vyhľadali články publikované od 1. januára 1990 do 31. decembra 2010. Vhodnými štúdiami boli prospektívne randomizované štúdie fázy II a III, ktoré porovnávali chemoterapiu založenú na cisplatine oproti necisplatinovej chemoterapii u pacientov so solídnymi nádormi. Zisťovali sme údaje o všetkých stupňoch VTE. Kvalita každej štúdie bola vypočítaná na základe Jadadových skóre. Stupne incidencie, relatívne riziká (RR) a 95% CI boli vypočítané s použitím modelu náhodných vplyvov.

Výsledky

Celkove bolo do štúdie zahrnutých 8 216 pacientov s rozličnými pokročilými solídnymi nádormi z 38 randomizovaných kontrolovaných štúdií. Incidencia VTE bola 1,92% (95% CI 1,07–2,76) u pacientov s chemoterapiou založenou na cisplatine a 0,79% (95% CI 0,45–1,13) u pacientov s chemoterapiou bez cisplatiny. Pacienti, ktorí dostávali cisplatinovú chemoterapiu, mali signifi kant ne vyššie riziko VTE (RR 1,67; 95% CI 1,25–2,23; p = 0,01). Najvyššie RR VTE bolo na základe exploratívnej podskupinovanej analýzy zistené u pacientov dostávajúcich týždňovú ekvivalentní dávku cisplatiny > 30 mg/m2 (2,71; 95% Cl 1,17–6,30; p = 0,02) a v štúdiách, ktoré boli publikované od roku 2000 do 2010 (1,72; 95% CI 1,27–2,34; p = 0‚01).

Záver

Cisplatina je asociovaná so signifikantne zvýšeným rizikom VTE u pacientov s pokročilými solídnymi nádormi pri porovnaní s chemoterapiou bez cisplatiny.

J Clin Oncol 30:4416-4426. © 2012 by American Society of Clinical Oncology

Celý článek naleznete v časopise Journal of Clinical Oncology číslo 1/2013 na straně 25

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Zdroj: Journal of Clinical Oncology