宫颈癌新辅助化疗临床疗效的meta分析

发布时间：2018-03-03 11:02

本文选题：宫颈癌　切入点：新辅助化疗　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：评价宫颈癌患者新辅助化疗的近期疗效及复发率、转移率和生存率,分析影响疗效的各种因素。方法：计算机检索PUBMED数据库、万方数据库、中国知网及有关文章的参考文献,手工检索山东大学图书馆及济南市第三人民医院图书馆有关宫颈癌新辅助化疗方面的期刊书籍和杂志。语种限英语和汉语,时间不限。试验组初始治疗方法为新辅助化疗联合手术,对照组初始治疗方法为单纯手术。对收集的资料进行评价,剔除不符合本文研究目的或不合质量要求的文章。对同质的研究采用RevMan5.1软件进行meta分析。以患者的临床疗效,术中及术后情况、化疗毒副作用、术后病理(淋巴结转移、宫旁浸润、脉管癌栓、阴道切缘、宫颈深肌层浸润)及复发率、转移率及3年、5年生存率为疗效观察指标,计算各个研究的RR值,通过合并RR值比较新辅助化疗组与对照组的临床疗效、术中及术后情况、化疗毒副作用、术后病理(淋巴结转移、宫旁浸润、脉管癌栓、阴道切缘、宫颈深肌层浸润)及复发率、转移率及3年、5年生存率,并探讨影响疗效的各种因素。结果：共有11个临床试验包括1332例病人符合纳入标准,其中五个为RCT,六个CCT,CCT有1例根据患者分期、年龄及个人意愿分组,其余均未详细描述分组方法,所有试验均未提及是否采用盲法。结果显示,新辅助化疗联合手术组较单纯手术组：1.术中及术后情况手术时间差异有统计学意义(IV,-12.53,95%CI,[-18.09,-6.97],PO.0001)；术中出血量差异无统计学意义(IV,-15.88,95%CI,[-76,87,45.1],P=0.61)；术后尿潴留差异无统计学意义(RR,0.70,95%CI,[0.21,2.32],P=0.56)。2.病理改变手术切缘阳性率差异有统计学意义(RR,0.55,95%CI,[0.37,0.82], P=0.003);淋巴结转移率差异有统计学意义(RR,0.51,95%CI,[0.38,0.70], P0.0001);宫旁浸润率差异有统计学意义(RR,0.51,95%CI,[0.31,0.90], P=0.02);脉管间隙浸润率差异有统计学意义(RR,0.41,95%CI,[0.29,0.56], P0.00001);3.总生存率3年生存率差异有统计学意义(RR,1.12,95%CI,[0.98,1.28],P=0.01)；5年生存率差异有统计学意义(RR,1.12,95%CI,[1.04,1.22], P=0.005);4.复发率差异有统计学意义(RR,0.57,95%CI,[0.34,0.97],P=0.04)；5.远处转移率差异有统计学意义(RR,0.37,95%CI,[0.17,0.82], P=0.01)。结论：新辅助化疗联合手术治疗和单纯手术治疗相比,可以缩短手术时间,但并不能减少术中出血量,不能减少术后尿潴留的发生率。可以降低影响预后的病理危险因素发生率,包括阴道切缘阳性、淋巴结转移、宫旁浸润、脉管间隙浸润,可以降低复发率和远处转移率,新辅助化疗可以提高患者3年及5年生存率,本研究无法证明年龄、肿瘤直径大小、分期、病理类型及分化、给药途径及化疗方案对新辅助化疗疗效的影响。
[Abstract]:Objective: to evaluate the recent curative effect, recurrence rate, metastasis rate and survival rate of neoadjuvant chemotherapy in patients with cervical cancer. Methods: PUBMED database, Wanfang database, Chinese knowledge network and related articles were searched by computer. To manually search the journal books and magazines of Shandong University Library and Jinan third people's Hospital Library on neoadjuvant chemotherapy for cervical cancer. The initial treatment method in the experimental group was neoadjuvant chemotherapy combined surgery, while in the control group, the initial treatment method was simple surgery. The data collected were evaluated. RevMan5.1 software was used for meta analysis. The clinical effect, intraoperative and postoperative conditions, side effects of chemotherapy, postoperative pathology (lymph node metastasis, lymph node metastasis) were analyzed. Periuterine invasion, vascular tumor embolus, vaginal margin, deep cervical myometrial infiltration) and recurrence rate, metastasis rate, 3-year and 5-year survival rate were used as therapeutic indicators. RR values of each study were calculated. The clinical efficacy, intraoperative and postoperative conditions, side effects of chemotherapy, postoperative pathology (lymph node metastasis, periuterine infiltration, vascular carcinoma embolus, vaginal margin) were compared between neoadjuvant chemotherapy group and control group by combining RR values. The recurrence rate, metastasis rate and 3-and 5-year survival rate were investigated. Results: a total of 11 clinical trials including 1332 patients met the inclusion criteria, five of them were RCTs, and one of the six CCT patients was grouped according to the patient's stage, age and personal wishes. The rest did not describe the grouping method in detail. No mention was made of the use of the blind method. The results showed that, The operative time of neo-adjuvant chemotherapy combined operation group was significantly different than that of simple operation group (IV-12.53-95 CI, [-18.09U -6.97] PO.0001C; there was no significant difference in intraoperative bleeding volume (IV-15.888-95 CI, [-768745.1] P0.61; postoperative urinary retention was not statistically significant RR0.70595 CI, [0.21 卤2.32] P0.566.32] P0.566.2.The pathological changes of the hands were not significant. There were significant differences in the positive rate of the resection margin, [0.37 卤0.82], P0. 003; the difference of lymph node metastasis rate was statistically significant; the difference of lymph node metastasis rate was statistically significant. [0.38 卤0.70], P0. 0001C; there was a significant difference in the periuterine infiltration rate between RR0. 51-95 CI, [0.31 卤0. 90], P0. 02; there was significant difference in vascular interstitial infiltration rate between RR0. 495 CI, [0. 2929 0. 56], P0. 001 0. 3. The overall 3 year survival rate was significant. There were significant differences in survival rate between RRX 1.1295CI, [0.981.28] and 5-year survival rate (RRX 1.1295CI, [1.041.22] P = 0.0051CI). There were significant differences in recurrence rate between RR0.5795CII, [0.3440.97] P0.04Ci and distant metastasis rate (0.37795 CI, [0.170.82] P0. 01). Conclusion: neoadjuvant chemotherapy combined with surgery can shorten the operative time, but it can not reduce the amount of intraoperative bleeding. The incidence of postoperative urinary retention can not be reduced. It can reduce the incidence of pathological risk factors affecting prognosis, including vaginal margin positive, lymph node metastasis, periuterine infiltration, vascular space infiltration, and reduce recurrence rate and distant metastasis rate. Neoadjuvant chemotherapy can improve the 3-year and 5-year survival rate of patients. This study could not prove the influence of age, tumor diameter, stage, pathological type and differentiation, administration route and chemotherapy regimen on the efficacy of neoadjuvant chemotherapy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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