Comparison of first line chemotherapy regimens for advanced soft tissue sarcoma: a network meta-analysis

The best first line chemotherapy regimen for advanced soft tissue sarcoma (ASTS) remains inconclusive. Here, we aimed to find the best first line chemotherapy regimen by performing a network meta-analysis. Regimens were compared in terms of overall survival (OS), overall response rate(ORR), progression free survival (PFS), and toxicity. Twenty-eight eligible trials with a total of 6928 patients were included. EC (epirubicin + cisplatin) was considered as the better regimen for advanced STS with probability of 61.9% in terms of OS. However, this regimen only have been evaluated in a single small trial and tend to have more hematological toxicities than doxorubicin. No regimen was superior to doxorubicin with significant statistical difference in terms of PFS and ORR, even aldoxorubicin behaved better than doxorubicin in the network analysis. Collectively, doxorubicin still can be selected preferentially for the first line chemotherapy for patients.

晚期软组织肉瘤（advanced soft tissue sarcoma, ASTS）的最佳一线化疗方案至今尚无定论。本研究旨在通过开展网络Meta分析（network meta-analysis），筛选晚期软组织肉瘤的最优一线化疗方案。研究从总生存期（overall survival, OS）、客观缓解率（overall response rate, ORR）、无进展生存期（progression free survival, PFS）及毒性反应四个维度对各化疗方案进行比较。最终纳入符合入组标准的28项临床试验，共计6928例患者。在总生存期维度，表柔比星联合顺铂（epirubicin + cisplatin, EC）被认为是更优方案，其优选概率达61.9%。但该方案仅在一项小型单中心试验中得到评估，且相较于多柔比星（doxorubicin），其血液学毒性发生率更高。在无进展生存期与客观缓解率维度，尚无任何方案在统计学上显著优于多柔比星；即便奥多柔比星（aldoxorubicin）在网络分析中表现略优于多柔比星，亦未达到统计学显著性差异。综上，多柔比星仍可作为晚期软组织肉瘤患者一线化疗的优先选择方案。