新辅助化疗联合同期放化疗在局部晚期宫颈癌治疗中疗效和安全性的Meta分析

发布时间：2018-09-05 12:15

【摘要】：目的:通过对比新辅助化疗联合同期放化疗和单独同期放化疗两种治疗模式在局部晚期宫颈癌治疗中的疗效及安全性,探讨局部晚期宫颈癌的有效治疗模式,为指导临床实践提供理论依据。方法:计算机检索Pub Med、Embase、The Cochrane Library、Web of Science、CNKI、CBM、万方等常用数据库,同时追溯纳入研究的参考文献。检索2016年10月前所有关于宫颈癌新辅助化疗的文献,检索语言限制为中文和英文。按照纳入和排除标准选择合格的文献进行数据合并,随机对照研究(RCT)采用改良后的Jadad量表进行质量评价,非随机对照研究(CCT)采用纽卡斯尔-渥太华量表(NOS)评价文献质量。统计学分析采用Review Manager 5.3软件进行,观察指标包括完全缓解率(CR)、客观缓解率(ORR)、总生存率(OS)、无病生存率(DFS)和毒副反应发生率。结果:共纳入8项研究包括2229例患者,其中3篇RCT、5篇CCT。meta分析结果显示:(1)新辅助化疗联合同期放化疗较单独同期放化疗提高了患者的完全缓解率(CR)和客观缓解率(ORR),CR[OR=1.85,95%CI:1.42~2.42,P0.00001],ORR[OR=2.48,95%CI:1.39~4.41,P=0.002]。(2)新辅助化疗联合同期放化疗未能提高患者总生存率,1年OS[OR=6.65,95%CI:0.54~82.08,P=0.14]、3年OS[OR=1.58,95%CI:0.76~3.30,P=0.22]、5年OS[OR=1.44,95%CI:0.74~2.78,P=0.28],差异比较均无统计学意义。但这一治疗策略提高了3年、5年DFS,3年DFS[OR=1.69,95%CI:1.09~2.62,P=0.02]、5年DFS[OR=0.17,95%CI:0.11~0.24,P0.00001]。(3)新辅助化疗联合同期放化疗组和单独同期放化疗组的毒副反应比较差异无统计学意义,骨髓抑制发生率[OR=0.70,95%CI:0.22~2.28,P=0.56],消化道反应发生率[OR=1.12,95%CI:0.58~2.16,P=0.84]、神经毒性反应发生率[OR=0.43,95%CI:0.09~2.02,P=0.93],两组上述毒副反应发生率相当。结论:我们的研究得出以下结论,在局部晚期宫颈癌治疗中,新辅助化疗联合同期放化疗提高了患者的近期缓解率和无病生存率,但在总生存率和减少毒副反应方面无帮助。
[Abstract]:Objective: to compare the efficacy and safety of neoadjuvant chemotherapy combined with concurrent radiotherapy and chemotherapy alone in the treatment of locally advanced cervical cancer. To provide theoretical basis for guiding clinical practice. Methods: Pub Med,Embase,The Cochrane Library,Web of Science,CNKI,CBM, Wanfang database was searched by computer and the references were included in the research. To search all the literatures on neoadjuvant chemotherapy for cervical cancer by October 2016, the search language is restricted to Chinese and English. According to the inclusion and exclusion criteria, qualified literature was selected for data consolidation, (RCT) was evaluated by modified Jadad scale, and (CCT) evaluated literature quality by Newcastle Ottawa scale (NOS). The statistical analysis was carried out with Review Manager 5.3 software. The observed indexes included complete remission rate, (CR), objective remission rate, (ORR), overall survival rate, (OS), disease-free survival rate, (DFS) and incidence of side effects. Results: a total of 8 studies including 2229 patients were included. The results of CCT.meta analysis in three RCT,5 articles were as follows: (1) Neoadjuvant chemotherapy combined with concurrent radiotherapy and chemotherapy improved the complete remission rate (CR) and objective remission rate (ORR) CR) of patients compared with chemotherapy alone. (2) Neoadjuvant chemotherapy combined with concurrent radiotherapy [OR=2.48,95%CI:1.39~4.41,P=0.002] did not increase the rate of complete remission. (2) Neoadjuvant chemotherapy combined with concurrent radiotherapy and chemotherapy did not increase the overall remission rate of patients. The overall survival rate, 1 year OS [OR=6.65,95%CI:0.54~82.08,P=0.14], 3 year OS [OR=1.58,95%CI:0.76~3.30,P=0.22], 5 year OS [OR=1.44,95%CI:0.74~2.78,P=0.28] had no statistical significance. However, the treatment strategy was improved by 3 years, 5 years DFS, 3 years DFS [OR=1.69,95%CI:1.09~2.62,P=0.02], 5 years DFS [OR=0.17,95%CI:0.11~0.24,P0.00001]. (3) there was no significant difference in side effects between neoadjuvant chemotherapy combined with concurrent radiotherapy and chemotherapy group and single concurrent radiotherapy and chemotherapy group. The incidence of bone marrow suppression [OR=0.70,95%CI:0.22~2.28,P=0.56], digestive tract reaction (OR=1.12,95%CI:0.58~2.16,P=0.84) and neurotoxicity reaction (OR=0.43,95%CI:0.09~2.02,P=0.93) were similar between the two groups. Conclusion: in the treatment of locally advanced cervical cancer, neoadjuvant chemotherapy combined with concurrent radiotherapy and chemotherapy can improve the short-term remission rate and disease-free survival rate, but not in the overall survival rate and the reduction of side effects.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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