中高危局限期前列腺癌大分割及常规分割放疗的疗效对比-Meta分析

发布时间：2018-04-26 22:43

本文选题：前列腺癌/中高危 + 大分割放疗　；参考：《河北北方学院》2017年硕士论文

【摘要】：前列腺癌是常见的男性恶性肿瘤之一,在我国的发病率逐渐上升,美国国家综合癌症网络(The National Comprehensive Cancer Network,NCCN)和欧洲泌尿外科学会(European Association of Urology,EAU)联合推荐中高危局限期前列腺癌(PCa)标准治疗方法是常规分割放疗联合内分泌治疗。然而,常规分割放疗治疗时间长达8周左右,治疗时间长,占用医疗资源多。PCaα/β值较小,根据放射生物模型,理论上PCa更适合大分割放疗,其中低危PCa大分割放疗研究较多,且技术较为成熟。但中高危PCa大分割放疗研究报道较少,且多为小样本量研究。因此,本文比较中高危局限期PCa大分割放疗与常规分割放疗的疗效、不良反应的差异,为临床治疗提供相应依据。通过计算机检索PubMed数据库,Embase数据库,Web of Science等数据库和相关期刊论文、中国科技期刊数据库和万方全文数据库。检索语言种类限制为英文和中文,检索时间不限。搜集有关中高危局限期PCa大分割放疗及常规分割放疗比较的临床对照研究资料,采用Collaboration协作网提供的Stata 12.0软件进行Meta分析。两组间差异采用风险比(hazard ratio,HR)、相对危险度(risk ratio,RR)及95%可信区间(95%CI)描述。根据纳入排除和标准,最终纳入5项包括1621例患者的临床对照研究资料。Meta分析结果显示:两组的总生存率(HR=1.00,95%CI:0.85-1.17,P=0.9800.05)和生化失败结果(RR=0.87,95%CI:0.68-1.12,P=0.2740.05)均相似。与常规分割放疗比较,虽然大分割放疗组≥2级急性胃肠不良反应发生率偏高(RR=1.94,95%CI:1.23-3.06,P=0.0040.05),但3级及以上急性胃肠不良反应两组无差异,且发生率低。两组≥2级急性泌尿系统不良反应(RR=1.03,95%CI:0.92-1.14,P=0.6260.05)、晚期≥2级胃肠(RR=1.17,95%CI:0.90-1.51,P=0.2380.05)和泌尿系统(RR=1.11,95%CI:0.94-1.30,P=0.2280.05)不良反应均相似。亚组分析结果显示:当常规分割放疗组总剂量≥78Gy时,大分割放疗组≥2级急性胃肠不良反应发生率依旧偏高(RR=1.93,95%CI:1.14-3.29,P=0.0150.05)。而OS率、生化失败结果、急性泌尿及晚期不良反应两组亚组分析结果无显著差异(P0.05)。中高危局限期PCa大分割放疗与常规分割放疗疗效相当,虽然大分割放疗组急性胃肠反应发生率略高于常规分割组,但两组晚期胃肠和泌尿系统反应并无差异,患者可耐受。
[Abstract]:Prostate cancer is one of the common male malignant tumors. The incidence of prostate cancer is increasing in our country. The United States National Comprehensive Cancer Network (The National Comprehensive Cancer Network, NCCN) and the European Society for Department of Urology (European Association of Urology, EAU) jointly recommend the standard treatment for high risk limited stage prostate cancer (PCa) is routine Fractionated radiotherapy combined with endocrine therapy, however, the treatment time of conventional fractionation radiotherapy is 8 weeks long, the treatment time is long and the medical resources are much more.PCa A / beta. According to the radiological biological model, PCa is more suitable for large fractionated radiotherapy, among which, the low risk PCa large fractionation radiotherapy is more and more mature. However, high risk PCa is widely divided. Therefore, this paper compares the effect of PCa large fractionation radiotherapy with conventional fractionated radiotherapy and the difference of adverse reactions in high risk limited period, and provides the basis for clinical treatment. The PubMed database, Embase database, Web of Science database and Chinese periodical full text data are retrieved by computer. Library, Chinese sci-tech journal database and Wanfang full text database. The types of retrieval languages are limited to English and Chinese, and the retrieval time is not limited. The clinical data of comparison of PCa large fractionation radiotherapy and conventional fractionated radiotherapy in middle risk limited period are collected, and Meta analysis is carried out by Stata 12 software provided by Collaboration cooperation network. The differences were hazard ratio (HR), relative risk (risk ratio, RR) and 95% confidence interval (95%CI). According to inclusion exclusion and criteria, the final inclusion of 5 clinical control data including 1621 patients,.Meta analysis showed that the total survival rate (HR=1.00,95%CI:0.85-1.17, P=0.9800.05) and biochemical failure results (R) in the two groups (R R=0.87,95%CI:0.68-1.12, P=0.2740.05) were all similar. Compared with conventional fractionated radiotherapy, although the incidence of acute gastrointestinal adverse reaction (RR=1.94,95%CI:1.23-3.06, P=0.0040.05) was higher in the larger division radiotherapy group (RR=1.94,95%CI:1.23-3.06, P=0.0040.05), there was no difference between the two groups, and the incidence of the acute gastrointestinal adverse reaction was low. Two groups (RR =1.03,95%CI:0.92-1.14, P=0.6260.05), the adverse reactions of the advanced gastrointestinal (RR=1.17,95%CI:0.90-1.51, P=0.2380.05) and urinary system (RR=1.11,95%CI:0.94-1.30, P=0.2280.05) were all similar. The subgroup analysis showed that the incidence of acute gastrointestinal adverse reactions in the large division radiotherapy group was still more than 2 when the total dose of the conventional fractionated radiotherapy group was more than 78Gy. RR=1.93,95%CI:1.14-3.29 (RR=1.93,95%CI:1.14-3.29, P=0.0150.05). But the results of OS, biochemical failure, acute urinary and late adverse reactions were not significantly different (P0.05). The high risk limited period PCa large fractionation radiotherapy was equivalent to the conventional fractionated radiotherapy, although the incidence of acute gastrointestinal reactions in the large fractionated radiotherapy group was slightly higher than that of the conventional division group. However, there was no difference between the two groups in the late gastrointestinal and urinary system response.

【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

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