关键词: 胶质母细胞瘤, 肿瘤电场治疗, 替莫唑胺, 贝伐珠单抗, 西仑吉肽, 网状Meta分析, 诊断, 有效性, 安全性, 生存情况

Abstract: Background　Tumor-treating fields（TTFields）with Stupp protocol and angiogenesis inhibitors with Stupp protocol have proved to be effective in the treatment of newly diagnosed glioblastoma，but there are few studies directly comparing their efficacies and safety. Objective　To compare the efficacy and safety of TTFields versus angiogenesis inhibitors in combination with Stupp protocol for newly diagnosed glioblastoma. Methods　The databases of PubMed，The Cochrane Library，EMBase and OVID were comprehensively searched from January 1，2004 to January 1，2020 for studies about newly diagnosed glioblastoma treated by TTFields with Stupp protocol compared with those treated by angiogenesis inhibitors with Stupp protocol. The literature information was extracted and stored in the Excel file，including the first author，country of the author，year of publication，number and age of participants，treatment scheme（experimental groups：Stupp protocol in combination with bevacizumab，cilengitide，or TTFields combined with other treatment regimens；control group：Stupp protocol），outcome indicators〔overall survival（OS），progression-free survival（PFS）〕 and adverse events. The quality of the included literatures was evaluated. Revman 5.3 and Stata 13.1 were used for network meta-analysis. Results　Seven studies were included，involving 1 859 cases and 1 566 controls，with a relatively high methodological quality. Seven therapies from studies were included in the network meta-analysis：TTFields with Stupp protocol，bevacizumab with Stupp protocol，bevacizumab with irinotecan，bevacizumab with irinotecan and Stupp protocol，cilengitide（twice a week）with Stupp protocol，cilengitide（five times a week）with Stupp protocol，and Stupp protocol. Through network meta-analysis，the 6-month OS rate of each treatment modality was ranked from high to low：TTFields with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with Stupp protocol > cliengitide（twice a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > bevacizumab with irinotecan > Stupp protocol. The one-year OS rate was ranked from high to low as follows：TTFields with Stupp protocol > bevacizumab with irinotecan> bevacizumab with Stupp protocol> cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > Stupp protocol. The 6-month PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan> bevacizumab with Stupp protocol > TTFields with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > cliengitide（five times a week）with Stupp protocol > cliengitide（twice a week）with Stupp protocol > Stupp protocol. The one-year PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan > bevacizumab with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > TTFields with Stupp protocol > cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > Stupp protocol. In terms of adverse events，Bevacizumab and irinotecan increased the incidence of treatment-related adverse events，but TTFields and cilengitide did not. Conclusion　TTFields with Stupp protocol seems to be safer and more effective，but whether it can be used as an alternative to other six therapies still needs to be verified.

Key words: Glioblastoma, Tumor-treating fields, Temozolomide, Bevacizumab, Cilengitide, The network meta-analysis, Diagnosis, Effectiveness, Security, Survival