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Выживаемость при таргетной химиотерапии нерезектабельных злокачественных новообразований желчевыводящей системы (систематический обзор и метаанализ)

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Цель. Оценка выживаемости пациентов с нерезектабельными злокачественными новообразованиями желче-выводящей системы при таргетной химиотерапии для выявления наиболее перспективных адъювантных схем. Материал и методы. Рассматривали публикации в базах PubMed Central, РИНЦ, Cochrane. Гетерогенность оценивали графически (блобограммы) и статистически (?2 и I2 ).Результаты. Метаанализ пятилетней выживаемости выявил большую объединенную оценку периода в основных группах, в которых применяли таргетную химиотерапию, – 295 ± 71 день (95% ДИ 144–408; p < 0,001) по сравнению с группами сравнения – 205 ± 81 день (95% ДИ 81–426; p < 0,001). Гетерогенность исследований была признана умеренной (I2 = 0%, p = 0,06). Значимых публикационных ошибок и предвзятости в обоих метаанализах не выявлено.Заключение. Таргетная химиотерапия увеличивает общую выживаемость больных нерезектабельными злокачественными новообразованиями желчных протоков. Наилучшую эффективность показала системная химиотерапия на основе гемцитабина и цисплатина с добавлением селективного ингибитора мутации IDH-1 ивосидениба.

Ключевые слова:
желчные протоки, холангиоцеллюлярный рак, таргетная химиотерапия, ивосидениб, метаанализ, bile ducts, cholangiocellular cancer, targeted chemotherapy, ivosidenib, meta-analysis

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Survival after targeted chemotherapy and unresectable biliary malignancies (systematic review and meta-analysis)

Aim. To evaluate the survival rate of patients with unresectable biliary malignancies under targeted chemotherapy in order to identify the most promising adjuvant regimens.Materials and methods. The study involves publications in PubMed Central, RSCI, and Cochrane databases. Heterogeneity was assessed graphically (blobograms) and statistically (? 2 and I2 ).Results. Meta-analysis of five-year survival revealed a greater pooled estimate of the period in the main groups treated with targeted chemotherapy – 295 ± 71 days (95% CI 144–408; p <0.001) against comparison groups – 205 ± 81 days (95% CI 81–426; p <0.001). Study heterogeneity was considered moderate (I2 = 0%, p = 0.06). No significant publication errors and biases were revealed in both meta-analyses.Conclusion. Targeted chemotherapy increases the overall survival of patients with unresectable malignancies of the bile ducts. Systemic chemotherapy based on gemcitabine and cisplatin with addition of ivosidenib, a selective inhibitor of mutant IDH1, showed the best efficacy.

Keywords:
желчные протоки, холангиоцеллюлярный рак, таргетная химиотерапия, ивосидениб, метаанализ, bile ducts, cholangiocellular cancer, targeted chemotherapy, ivosidenib, meta-analysis