可切除食管癌术前与术后放化疗对比Meta分析

发布时间：2019-03-08 20:49

【摘要】：目的食管癌患者就诊时大多属中晚期,单纯手术疗效不佳,需结合放化疗提高疗效,但手术与放化疗治疗顺序备受争议。本研究通过对比中晚期可切除食管癌术前与术后放化疗2种治疗模式的疗效及安全性,探寻治疗食管癌的有效治疗模式,为指导临床实践提供理论依据。方法计算机检索The Cochrane Library、Embase、PubMed、Web of Science、CBM和CNKI,同时辅佐其他检索途径,检索2016-10前所有关于对比食管癌术前放化疗与术后放化疗的临床研究。随机对照研究(randomized controlled trial,RCT)采用Cochrane质量评价标准评价文献质量,非随机对照研究采用纽斯卡尔-渥太华量表(newcastle-ottawa scale,NOS)质量评价标准评价文献质量,统计学分析采用Review Manager5.3软件。本Meta分析遵循系统综述与荟萃分析优先报告条目(PRISMA)规范。结果共纳入1个RCT和5个非随机对照研究,Meta分析结果显示,1年生存率(OR=1.24,95%CI:0.96~1.61,P=0.09)、3年生存率(OR=1.25,95%CI:1.00~1.55,P=0.05)、5年生存率(OR=1.39,95%CI:0.93~2.06,P=0.11)和术后并发症发生率(OR=1.45,95%CI:0.81~2.60,P=0.21)差异均无统计学意义。亚组分析显示,国内人群1年生存率(OR=1.30,95%CI:0.48~3.58,P=0.61)、国外人群1年生存率(OR=1.37,95%CI:0.79~2.38,P=0.26)、国内人群3年生存率(OR=1.16,95%CI:0.90~1.49,P=0.25)和国外人群3年生存率(OR=1.55,95%CI:1.00~2.41,P=0.05)差异均无统计学意义。结论中晚期可切除食管癌术前放化疗与术后放化疗疗效及安全性相似,临床上可酌情考虑后决定手术与放化疗治疗顺序,但仍有待大量多中心、前瞻性随机对照临床实验证实。
[Abstract]:Objective most of the patients with esophageal cancer are middle and late stage. Surgery alone is not effective and should be combined with radiotherapy and chemotherapy to improve the curative effect. However, the sequence of operation and radiotherapy and chemotherapy is controversial. In this study, the efficacy and safety of preoperative and postoperative radiotherapy and chemotherapy for advanced resectable esophageal cancer were compared, and the effective treatment model for esophageal cancer was explored in order to provide a theoretical basis for guiding clinical practice. Methods A computer search of The Cochrane Library,Embase,PubMed,Web of Science,CBM and CNKI, was carried out to search all pre-and post-operative radiotherapy and chemotherapy studies of esophageal cancer before 2016-10. The results were compared with those of pre-and post-operative radiotherapy and chemotherapy. Randomized controlled study (randomized controlled trial,RCT) used Cochrane quality evaluation criteria to evaluate literature quality, and non-randomized controlled studies assessed literature quality with newcastle-ottawa scale,NOS quality evaluation criteria, and the quality of literature was evaluated by Nuschard-Ottawa scale (newcastle-ottawa scale,NOS). Review Manager5.3 software was used for statistical analysis. This Meta analysis follows the system review and meta-analysis priority report entry (PRISMA) specification. Results A total of 1 RCT and 5 non-randomized controlled studies were included. Meta analysis showed 1-year survival rate (OR=1.24,95%CI:0.96~1.61,P=0.09) and 3-year survival rate (OR=1.25,95%CI:1.00~1.55,P=0.05). There was no significant difference in 5-year survival rate (OR=1.39,95%CI:0.93~2.06,P=0.11) and postoperative complication rate (OR=1.45,95%CI:0.81~2.60,P=0.21). Subgroup analysis showed 1-year survival rate (OR=1.30,95%CI:0.48~3.58,P=0.61) in domestic population and 1-year survival rate (OR=1.37,95%CI:0.79~2.38,P=0.26) in foreign population. There was no significant difference between 3-year survival rate (OR=1.16,95%CI:0.90~1.49,P=0.25) in domestic population and 3-year survival rate (OR=1.55,95%CI:1.00~2.41,P=0.05) in foreign population. Conclusion the efficacy and safety of preoperative radiotherapy and chemotherapy for advanced resectable esophageal cancer are similar to those of postoperative radiotherapy and chemotherapy. The sequence of operation and radiotherapy and chemotherapy can be considered in clinical practice. However, a large number of multicenter, prospective randomized controlled clinical trials are still needed to confirm the efficacy and safety of preoperative radiotherapy and chemotherapy.
【作者单位】：遵义医学院附属医院胸部肿瘤科;贵阳市第一人民医院功能科;贵州省人民医院肿瘤科;
【分类号】：R735.1

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