强化与常规方案化疗对骨肉瘤预后影响的Meta分析

发布时间：2018-08-26 16:29

【摘要】：[目的]探讨与常规方案相比,强化方案化疗是否能够改善骨肉瘤患者的预后。[背景]20世纪80年代末,骨肉瘤患者的生存率随新辅助化疗在临床中广泛的推广应用而得到了极大的改善。目前在骨肉瘤治疗方面虽然有很多临床和基础研究,但其疗效却没有取得较大的改善和突破。部分学者认为要提高患者的生存率,可以使用强化方案进行化疗。为此,我们进行本项研究,旨在探讨与常规方案化疗相比,强化方案化疗是否能够改善骨肉瘤患者的预后。[方法]检索 MEDLINE/PubMed,EMBASE,OVID,BIOSIS Previews,and Cochrane等数据库中的相关研究。检索时间为创刊至2016年10月。纳入将骨肉瘤强化方案与常规方案化疗进行对比的随机对照试验和临床对照试验,并对各项研究的循证证据等级进行评价。从纳入的文献中提取研究对象的特征,干预措施,随访时间,结局预后等相关指标,通过Review Manager 5.3软件对相关结局指标进行Meta分析,相关结果经全面分析讨论后得出最终结论。[结果]共纳入12项研究(其中RCT8项,CCT4项),4112例骨肉瘤患者。所有纳入的研究均由两名独立的研究员采用PEDro质量评分标准进行评价,得分在5-8之间。其中11项研究被认为是高质量的文献研究(得分≥6分),1项研究的质量相对较低(得分6分)。各项研究在方法学总体上是无明显偏倚。Meta分析最终的结果显示:强化方案化疗组与常规方案化疗组在3年无瘤生存率(OR,1.01; 95% CI,[0.74-1.37]; P=0.97),5 年无瘤生存率(OR, 1.00; 95% CI,[0.86-1.17]; P=0.97),5 年总生存率(OR, 1.04; 95% CI,[0.87-1.26]; P=0.64)及组织学反应良好者所占的比率(OR, 1.12; 95% CI,[0.78-1.60]; P=0.55)上无明显差异。数据的汇集分析结果显示与常规方案化疗组相比,强化方案化疗组患者的局部复发率较低(OR,0.60; 95% CI,[0.42-0.85]; P=0.004)。[结论]辅助化疗的应用使骨肉瘤患者的预后得到了极大的改善。对化疗药物的组织反应性是肿瘤细胞固有的生物学特性,与化疗剂量和强度无关,目前尚无确切的研究证据表明使用强化方案化疗可以使骨肉瘤患者的远期生存率得到改善。鉴于强化方案化疗会增加患者的毒副作用,且会给患者带来更大的经济负担,因此提高骨肉瘤患者的生存率,强化方案似乎不是最佳的选择。将来的研究重点应致力于探索出一种有效的手段对骨肉瘤的敏感性进行调控,或者研发新疗效显著且毒性温和的药物,在今后的临床工作中,尽可能为患者选择最佳,最有效的药物,根据具体情况制定个体化化疗方案,才能在骨肉瘤的生存率和生活质量方面取得突破。
[Abstract]:Objective: to investigate whether intensive chemotherapy can improve the prognosis of osteosarcoma patients. Background: in the late 1980s, the survival rate of osteosarcoma patients improved greatly with the extensive application of neoadjuvant chemotherapy in clinical practice. Although there are many clinical and basic researches in the treatment of osteosarcoma, the curative effect has not been improved. Some scholars believe that intensive chemotherapy can be used to improve the survival rate of patients. Therefore, we conducted this study to investigate whether intensive regimen chemotherapy can improve the prognosis of patients with osteosarcoma compared with conventional regimen chemotherapy. [methods] the relevant research in MEDLINE/PubMed,EMBASE,OVID,BIOSIS Previews,and Cochrane and other databases was searched. The search time is from inception to October 2016. A randomized controlled trial and a clinical controlled trial were included to compare the enhanced osteosarcoma regimen with the conventional regimen, and the evidence-based evidence levels of each study were evaluated. The characteristics, intervention measures, follow-up time, outcome prognosis and other related indicators were extracted from the included literature. The final conclusions were obtained by Meta analysis of the relevant outcome indicators by Review Manager 5.3 software. [results] A total of 4112 patients with osteosarcoma were included in 12 studies (including RCT8 item CCT 4). All of the included studies were evaluated by two independent researchers using the PEDro quality score, with scores ranging from 5 to 8. Eleven of these studies were considered high quality literature studies (score 鈮，

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