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

摘要： 背景　肿瘤电场治疗（TTFields）和血管抑制剂联合Stupp，在治疗新诊断胶质瘤方面均取得了较好的效果，但目前关于两者之间直接对比结果的研究较少。目的　探究在新诊断胶质母细胞瘤患者中，TTFields及血管抑制剂联合Stupp的有效性及安全性。方法　全面检索PubMed、The Cochrane Library、EMBase、OVID数据库，检索时间为2004-01-01至2020-01-01。采用Excel软件提取文献信息，信息包括：第一作者、国家、发表年份、纳入患者例数、年龄、治疗方案（试验组：贝伐珠单抗、西仑吉肽、TTFields联合其他治疗方案；对照组：Stupp）、结局指标〔总生存期（OS）、无进展生存期（PFS）〕以及不良事件发生情况等。对纳入文献进行质量评估并采用RevMan 5.3和Stata 13.1统计软件进行网状Meta分析。结果　本研究共纳入7篇文献，文献质量均较高，其中试验组纳入患者1 859例、对照组纳入患者1 566例。网状图中包括7种不同的治疗方案：TTFields联合替莫唑胺（TTFields+ Stupp）、贝伐珠单抗联合替莫唑胺（Bev+Stupp）、贝伐珠单抗联合伊立替康（Bev+Iri）、贝伐珠单抗联合伊立替康再联合替莫唑胺（Bev+Iri+Stupp）、西仑吉肽联合替莫唑胺（Cilengitide 2次/周+Stupp）、西仑吉肽联合替莫唑胺（Cilengitide 5次/周+Stupp）和替莫唑胺（Stupp）。通过网状Meta分析，发现各治疗方案6个月OS从高到低排序依次是：TTFields+Stupp>Cliengitide 5次/周+ Stupp>Bev+Stupp>Cliengitide 2次/周+ Stupp>Bev+Iri+Stupp>Bev+Iri>Stupp；1年OS从高到低排序依次是：TTFields+ Stupp>Bev+Iri>Bev+ Stupp>Cliengitide 2次/周+Stupp>Cliengitide 5次/周+Stupp>Bev+Iri+Stupp>Stupp；6个月PFS从高到低排序依次是：Bev+Iri>Bev
+ Stupp>TTFields+ Stupp>Bev+Iri+Stupp>Cliengitide 5次/周+ Stupp>Cliengitide 2次/周+ Stupp>Stupp；1年PFS从高到低排序依次是：Bev+Iri>Bev+ Stupp>Bev+Iri+Stupp>TTFields+ Stupp>Cliengitide 2次/周+ Stupp>Cliengitide 5次/周+ Stupp>Stupp。不良事件方面：贝伐珠单抗和伊立替康增加了患者不良事件发生率，TTFields和西仑吉肽并没有增加不良事件的发生率。结论　TTFields+ Stupp方案治疗新诊断胶质母细胞瘤似乎更加安全、有效，但是否可替代其他几种治疗方案，还需进一步论证。

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