关于补充醋酸甲地孕酮(MA)对患有厌食-恶病质综合征的癌症患者的影响,存在不一致的证据。这篇综述旨在研究补充MA对癌症相关厌食症/恶病质患者的剂量反应效应。在PubMed中搜索相关关键词,Scopus和ISIWebofScience从开始到2023年6月进行随机对照试验(RCT),检查MA对癌症相关恶病质患者病理的影响。我们的主要结果是体重和食欲的变化。然而,疲劳和生活质量是次要结局.使用随机效应方法估计平均差(MD)和95%置信区间(95%CI)。确定了13项试验,包括1229名参与者(平均年龄60岁)。我们的最高与最低分析的结果表明,补充MA与体重增加无关(MD:0.64kg,95%CI[-0.11,1.38],P=0.093,I2=69.1%;等级=非常低的确定性)。12次试验,包括来自1369名患者的14种效应大小(干预=689,对照=680),提供了MA对体重影响的数据。亚组分析显示,短期干预(≤8周)和联合放疗/化疗作为同步治疗后,体重显着增加。线性剂量-反应荟萃分析表明,每增加200毫克/天的MA消耗量,体重增加显着增加(MD:0.44;95%CI[0.13,0.74],P=0.005;I2=97.1%);但是,影响的幅度很小。根据合并效应大小,MA给药显著影响生活质量(MD:1.15,95%CI[0.76,1.54],P<0.001,I2=0%;n=2个RCT,包括176例患者;GRADE=非常低的确定性)。然而,补充MA对食欲没有显著影响(MD:0.29,95%CI[-0.05,0.64],P=0.096,I2=18.3%;n=3个RCT,包括163名患者;GRADE=非常低的确定性)和疲劳(MD:0.14,95%CI[-0.09,0.36],P=0.236,I2=0%;n=2个RCT,包括300名患者;GRADE=非常低的确定性)。证据的确定性很低,补充MA可能不会导致体重增加和其他结果的显着增加。
There is inconsistent evidence relating to the effects of megestrol acetate (MA) supplementation on cancer patients suffering from anorexia-cachexia syndrome. This review aimed to examine the dose-response effect of MA supplementation in patients with cancer-associated anorexia/cachexia. Relevant keywords were searched in PubMed, Scopus and ISI Web of Science from inception to June 2023 for randomized controlled trials (RCTs) examining the effect of MA on pathologies in patients with cancer-associated cachexia. Our primary outcomes were changes in body weight and appetite. However, fatigue and quality of life were secondary outcomes. The mean difference (MD) and 95% confidence interval (95% CI) were estimated using the random-effects method. Thirteen trials comprising 1229 participants (mean age 60 years) were identified. The results of our highest versus lowest analysis revealed that MA supplementation was not associated with any increase in body weight (MD: 0.64 kg, 95% CI [-0.11, 1.38], P = 0.093, I2 = 69.1%; GRADE = very low certainty). Twelve trials, including 14 effect sizes derived from 1369 patients (intervention = 689, control = 680), provided data on the effect of MA on body weight. Subgroup analyses showed a significant increase in body weight following short-term intervention (≤8 weeks) and a combination of radiation/chemotherapy as concurrent treatment. A linear dose-response meta-analysis indicated that each 200 mg/day increment in MA consumption had a significant increase in weight gain (MD: 0.44; 95% CI [0.13, 0.74], P = 0.005; I2 = 97.1%); however, the magnitude of the effect was small. MA administration significantly affected the quality of life based on pooled effect sizes (MD: 1.15, 95% CI [0.76, 1.54], P < 0.001, I2 = 0%; n = 2 RCTs including 176 patients; GRADE = very low certainty). However, no significant effect of MA supplementation was observed on appetite (MD: 0.29, 95% CI [-0.05, 0.64], P = 0.096, I2 = 18.3%; n = 3 RCTs including 163 patients; GRADE = very low certainty) and fatigue (MD: 0.14, 95% CI [-0.09, 0.36], P = 0.236, I2 = 0%; n = 2 RCTs including 300 patients; GRADE = very low certainty). With very low certainty of the evidence, MA supplementation may not lead to a significantly increased weight gain and other outcomes.